Objective To assess the effects of amniotic membrane transplantation combined with conjunctival flap covering ( double cover) as the treatment for deep bacterial corneal ulcer. Methods 30 patients with deep corneal ulcer received either double cover ( i. e. , amniotic membrane and conjunctival flap) or simple cover ( i. e. , amniotic membrane alone) after surgical debridement. Patients were followed up for 3~l0 months. Results 15 patients received double cover treatment. 2 of them were found to have conjunctival flap fallback and were treated again. Amniotic membrane dissolved in 1 patient. There was no perforation, and all ulcer cured. Visual acuity improved by 0. 1 in 8 eyes. In patients received simple cover, amniotic membrane shed was found in 7 eyes and in only 2 eyes visual acuity improved over 0. 1. Conclu-sions Amniotic membrane transplantation can promote rapid repair of corneal ulcers, reduce scar formation, and provide an ideal base film. Conjunctival flap, in addition to amniotic membrane, can promote blood circulation and help the topical medication to penetrate and reach deep corneal tissue, and ultimately to prevent perforation.%目的 探讨羊膜移植联合结膜瓣遮盖(复式遮盖)术治疗深层细菌性角膜溃疡的可行性,并对其疗效进行评价.方法 观察角膜深层溃疡濒临穿孔患者30例(30只眼),分为复式遮盖和单纯遮盖组(单纯羊膜移植术),手术清创后采用抗体阴性无菌处理后的新鲜羊膜,于角膜深基质层溃疡底层放置2~3层羊膜,并将邻近的结膜瓣加压遮盖于羊膜表面,随访3~10个月,观察角膜溃疡愈合情况.结果 复式遮盖组的15只眼,术后有2只眼结膜瓣回退,再次行球结膜覆盖;有1只眼羊膜自行溶解,无1例穿孔,溃疡均治愈,视力提高0.1以上8只眼.单式移植组中1周后羊膜脱落7只只眼,视力提高0.1以上2只眼.结论 羊膜移植能促进角膜溃疡快速修复,减少瘢痕形成,为角膜溃疡缺损区提供理想的基底膜,在其上加固球结膜瓣(复式遮盖)可促进局部血液循环并使药物向溃疡处缓慢渗透,达到控制炎症预防角膜穿孔的目的.
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