【作者】 姚莉；

【导师】 赵敏；

【作者基本信息】 重庆医科大学 ， 眼科学， 2010， 硕士

【摘要】 目的探讨重症化脓性角膜炎手术治疗的疗效,评价早期及适时手术干预治疗化脓性角膜炎的价值。方法对2006年1月至2009年12月在重庆医科大学附属第一医院眼科住院治疗的重症化脓性角膜炎部分病例进行手术治疗。包括细菌感染35例,真菌感染20例及混合感染6例,共61例(61眼); 7例术前角膜已穿孔,18例前房积脓超过1/3;手术方式:穿透性角膜移植(PKP)46例,板层角膜移植(LKP)8例,其它手术7例。随访3-12个月,观察眼球保存情况、术后视力变化、感染复发及其并发症。结果1.术后56例成功保住眼球,4例摘除眼球,1例失访;2.术前78.7%(48例)视力小于0.02,其中有一半以上是仅有手动甚至光感视力,术后绝大部分视力有提高,51.8%(29例)视力大于0.02,有13例术后视力大于0.1;3.感染复发6例,其中3例药物治疗无效、病情进展极快最终摘除了眼球,3例再次手术后保住眼球;4.继发性青光眼7例,6例用药后眼压控制良好,1例因视功能丧失伴剧痛后摘除眼球;并发性白内障15例;5.排斥反应17例, 3例行二次手术后稳定,1例因排斥放弃治疗。结论1、手术是治疗重症化脓性角膜炎的有效方式,其中主要是角膜移植特别是PKP对挽救重症角膜炎患者眼球,改善视功能有重要作用。2、对重症化脓性角膜炎早期及适时进行手术治疗,大部分患者能挽救眼球,并不同程度的提高视力。3、在角膜穿孔较小而无合适角膜材料情况下,用结膜瓣遮盖或羊膜移植(AMT)可以修复溃疡,为二次行光学性治疗创造条件。更多还原

【Abstract】 ObjectiveTo study the therapeutic effect of operation on severe suppurative keratitis and to evaluate the essentiality of early time and in time operation.MethodsWe choosed 61patients(61eyes) with refractory ruppurative keratitis which had been treated for operative therapy at the first affiliated hospital,Chongqing medical university, from Jan.2006 to Dec.2009.Including bacterial infection 35 eyes,fungal infection 20eyes,and mixed infection 6 eyes. 7eyes bad been perforated. 18eyes bad hypopyon exceed 1/3anterior chamber. Regular communicate with patients of post-operation .The follow-up ranged from 3-12months.The preservation of eyeballs, post-operative visual acuity and complications were documented.Results1 56 eyes were preserved after the operation,4eyes enucleated,1eye lost.2 Most patients had a restoration of visual function,.3 Infection recurred in 6 eyes,3 of which were controlled with sencondary operation,the others were enucleated because of the uncontrolled endophthalmitis.4 7eyes occurred secondary glaucoma, the intraocular pressure of 6 eyes was controlled medically and surgically,1eye enucleated for severe pain and complete visual loss. Complicated cataract occurred in 15 eyes.5 Graft rejection was observed in 17 eyes, 3received secondary corneal transplantation,1 eye refused further therapy.Conclusion1 Operation is an effective way for preservation of eyeballs and restoration of visual function in patients eyes with severe suppurative keratitis. Therapeutic keratoplasty especially penetrating keratoplasty may treat severe infectious keratitis effectively.2 High cure rates are achievable and visual acuity is elevated by early time and in time operation on severe suppurative keratitis.3 Amniotic membrane transplantation and conjunctival flap covering surgery are effective in promoting epithelialization and could be performed as an emergent procedure until a donor cornea is available.更多还原