深板层角膜切除联合自体全角膜结膜筋膜瓣遮盖术治疗老年严重角膜溃疡

摘要

Objective To observe the effect of deeper lamellar keratoplasty combined with total corneal conjunctival-fascial flap covering surgery in the treatment of senile severe keratohelcosis. Methods A retrospective analysis on clinical data was performed on 55 senile cases (55 eyes) who were diagnosed severe keratohelcosis (no perforation) in our hospital form January 2006 to April 2013. It was invalid with 2 weeks of systemic and topical medication treatment, and they were unwilling or unable to accept the corneal transplantation. The surgery of deeper lamellar keratoplasty combined with total corneal conjunctival-fascial flap covering were performed, and further postoperative drug treatment was based on the primary diseases, stitched at 15-20 days postoperative-ly, they were followed up for 3~9 months. Results In 54 cases, corneal irritation symptoms reduced significantly postoperatively, and disappeared at 1 month or so, the thickness of conjunctiva-fascia-cornea was near to 1/2 normal corneal thickness at 2~3 months, keratohelcosis healed eventually, without complications, such as corneal perforation, corneal staphyloma etc. One case was complicated with corneal lysis, severe endophthalmitis, and ocular evisceration was applied finally. The total cure rate was 98.2%. Visual acuity of 40 eyes (72.7%) was improved postoperatively, there were statistical differences between visual acuity of pre-oper-ation and post-operation (χ2=10.03,P<0.05). Conclusion It is effective for deeper lamellar keratoplasty combined with total corneal conjunctival and fascial flap covering surgery which could cure keratohelcosis and save the eyeball, in the treatment of elderly pa-tients with severe keratohelcosis, in whom severe endophthalmitis can be treated with ocular evisceration once it is found.%目的：探讨应用深板层角膜切除联合全角膜结膜筋膜瓣遮盖术治疗老年严重角膜溃疡的治疗效果。方法回顾性分析2006年1月-2013年4月在该院确诊的严重角膜溃疡(无穿孔)老年患者55例(55眼)，经2周全身和局部用药治疗无效，或病情加重，不愿或不能接受角膜移植，行深板层角膜切除联合全角膜结膜筋膜瓣遮盖术，术后对原发病继续药物治疗，15~20 d拆线。术后随访3~9个月。结果术后54例患者角膜刺激症状明显减轻，1个月后消失，2~3个月时角结膜筋膜厚度稳定，接近1/2角膜厚度，溃疡全部愈合，未见角膜穿孔、角膜葡萄肿等并发症。1眼出现角膜溶解、重度眼内炎，行眼内容剜除术。总治愈率98.2%。55眼中40眼术后视力较术前有提高，占(72.7%)，与术前相比差异有统计学意义(χ2=10.03，P<0.05)。结论对药物治疗无效的采用深板层角膜切除联合全角膜结膜筋膜瓣遮盖术可以治愈老年严重角膜溃疡，保存眼球。并发重度眼内炎者可行眼内容剜除术。