作者：杨锦，李 冰，杨付合
作者单位：1中国山西省太原市，山西医科大学眼科；2中国山西省太原市，山西省眼科医院；3中国山西省运城市眼科医院
【摘要】 目的：观察羊膜填塞法联合配戴软性角膜接触镜治疗角膜溃疡性穿孔的临床效果，了解此方法的有效性、安全性和局限性。 方法：对11例(11眼)感染性角膜溃疡穿孔的患者采用羊膜填塞治疗。其中，真菌性角膜溃疡穿孔3眼，病毒性角膜溃疡穿孔2眼，细菌性角膜溃疡穿孔5眼，单疱病毒性合并细菌感染者1眼。溃疡穿孔范围0.5～2mm。用羊膜填塞穿孔、用另一羊膜覆盖于整个角膜表面，配戴软性角膜接触镜。 结果：术后1d,11例患者前房均形成，穿孔区密闭良好，随访期间前房深度正常。手术后6wk有完好上皮覆盖，穿孔区角膜厚度逐渐增加,溃疡周边炎症反应减退。术后5mo溃疡瘢痕愈合，溃疡区的角膜厚度稳定。11眼术后视力均有不同程度提高。随访期间未出现复发及严重的并发症。 结论：羊膜填塞法联合配戴软性角膜接触镜治疗<2mm的角膜溃疡性穿孔是有效、安全的，但此方法术后角膜溃疡是瘢痕愈合，适用于穿孔区非角膜中央的患者。
【关键词】 角膜溃疡穿孔；羊膜填塞；软性角膜接触镜
Observation of clinical therapeutic effect of amniotic plugging associated with soft corneal contact lens to treat cornea ulcer perforation
Jin Yang1, Bing Li2, FuHe Yang3
1Department of Ophthalmology, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China; 2 Shanxi Eye Hospital, Taiyuan 030002, Shanxi Province, China; 3 Yuncheng Eye Hospital, Yuncheng 044000, Shanxi Province, China
AbstractAIM: To know the effectively, safety and limitations of amniotic plugging associated with soft corneal contact lens by observing its therapeutic effect among patients with cornea ulcer perforation.
METHODS: Eleven cases (11 eyes) with infected corneal ulcer perforation were treated by amniotic plugging, in which, 3 eyes were with fungus corneal ulcer perforation, 2 eyes with virus corneal ulcer perforation, 5 eyes with bacterial corneal ulcer perforation and 1 eye with herpes simplex associated with bacterial corneal ulcer perforation. The ranges of ulcer perforation was between 0.5 and 2mm. An amnion was used to stuff perforations, and another amnion was covered on the surface of entire corneal. Soft contact lens was worn eventually.
RESULTS: One day after operation, all 11 patients anterior chambers were well formed, perforation area closed tightly, and anterior chambers depth were normal during the period of followup. Six weeks later, perfect epithelium covered; in perforation area the corneal thickness increased gradually; inflammatory reaction around ulcer disappeared. Five months later, the ulcers scar healed, and the corneal thickness was stable. All of their vision had improved with different degrees. Recurrence and sever complications didnt happen during the period.
CONCLUSION: Its effective and safe to cure corneal ulcer perforations whose width is less than 2mm by employing amniotic plugging associated with soft corneal contact lens, but it's healed scarred lastly. So the method is suitable to the patients with ulcer area out of the center.
KEYWORDS: cornea ulcer with perforation; amniotic plugging; soft corneal contact lens
Yang J, Li B, Yang FH. Observation of clinical therapeutic effect of amniotic plugging associated with soft corneal contact lens to treat cornea ulcer perforation. Int J Ophthalmol(Guoji Yanke Zazhi) 2008;8(11):23282329
0引言
临床上由于感染引起的角膜溃疡性穿孔是很多见的，治疗有穿透性角膜移植术、板层角膜移植术、结膜瓣遮盖术、羊膜覆盖术、手术缝合等方法。为寻求一种简单易行、经济实用、在穿透性角膜移植材料缺乏的情况下，我院采用羊膜填塞法联合配戴软性角膜接触镜治疗感染性角膜溃疡穿孔11例取得较满意效果，现报告如下。
1对象和方法
1.1对象 角膜溃疡穿孔患者11例（11眼），其中右眼4例，左眼7例，年龄43～70岁，11例穿孔中，真菌性角膜溃疡穿孔3眼，病毒性角膜溃疡穿孔2眼，细菌性角膜溃疡穿孔5眼，单疱病毒性合并细菌感染者1眼。术前视力：手动～0.04者5眼，0.05～0.1者3眼，0.2～0.4者3眼。穿孔偏鼻侧的1眼，偏颞侧4眼，偏上方2眼，偏下方4眼。穿孔大小均在0.5～2mm，穿孔周边有不同程度的浸润病灶，药物控制炎症后均表现为无前房、低眼压和虹膜嵌顿。
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