Sun Guang-Hua, Li Su-Xia, Gao Hua, Zhang Wen-Bo, Zhang Mei-Ai, Shi Wei-Yun
Department of Ophthalmology, Qingdao University Medical College, Qingdao University, Qingdao 266071, Shandong Province, China.
Int J Ophthalmol. 2012;5(1):88-91. doi: 10.3980/j.issn.2222-3959.2012.01.18. Epub 2012 Feb 18.
To study the clinical observation of removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis.
A retrospective study was done to 10 patients (10 eyes) who had accepted removal of the necrotic corneal tissue combined with conjunctival flap covering surgery for fungal keratitis,the diagnosis by corneal scraping and smear examination or confocal microscopy check hyphae.Local and systemic antifungal therapy more than one week for all patients, corneal ulcer enlarge or no shrink.Slit lamp microscope examination the diameter of corneal ulcer about 2mm-4mm.Anterior segment optical coherence tomography (AS-OCT) examine the depth of corneal ulcer between 1/3-1/2,infiltrate corneal stroma about 20um-80um,the diameter of corneal ulcer about 3mm-6mm.Type-B ultrasonic exclusion endophthalmitis. Complete removal lesions until transparent of stroma, make conjunctival flap equal or greater than ulcer 1mm nearby conjunctiva. Continued antifungal therapy. The vision, fungal recurrence, conjunctival flap rollback or desquamate were analysed.
Ten patients had success done this surgery, the corneal ulcer was not enlarge and healing afteroperation.7 cases were bridging conjunctival flap and 3cases were single conjunctival flap. Preoperation vision above 0.1 had 8 cases,7 cases had vision above 0.1 one week after surgery, while 1 cases vision droped from 0.3 to 0.05.There was not recurrent for fungal,2 cases conjunctival flap rollback:1 case was bridging and 1case was single flap, no conjunctival flap desquamate.
It is safe and effective to perform removal of the necrotic corneal tissue combined with conjunctival flap covering surgery under the guidance of the AS-OCT in treatment of fungal keratitis which werenot sensitive or aggravate for antifungal drugs.
探讨在AS-OCT引导下切除坏死角膜组织联合结膜瓣覆盖术治疗真菌性角膜炎的临床观察。
回顾性分析10例（10眼）接受坏死角膜组织切除联合结膜瓣覆盖术治疗真菌性角膜炎的患者，通过角膜刮片及涂片检查或共焦显微镜检查菌丝确诊。所有患者局部及全身抗真菌治疗1周以上，角膜溃疡仍扩大或无缩小。裂隙灯显微镜检查角膜溃疡直径约2mm - 4mm。眼前节光学相干断层扫描（AS-OCT）检查角膜溃疡深度为1/3 - 1/2，角膜基质浸润约20um - 80um，角膜溃疡直径约3mm - 6mm。B型超声排除眼内炎。彻底清除病灶直至基质透明，在靠近结膜处制作结膜瓣使其等于或大于溃疡1mm。继续抗真菌治疗。分析视力、真菌复发、结膜瓣回退或脱落情况。
10例患者手术成功，术后角膜溃疡未扩大且愈合。7例为桥接结膜瓣，3例为单个结膜瓣。术前视力高于0.1者8例，术后1周7例视力高于0.1，1例视力从0.3降至0.05。真菌无复发，2例结膜瓣回退：1例为桥接瓣，1例为单个瓣，无结膜瓣脱落。
在AS-OCT引导下切除坏死角膜组织联合结膜瓣覆盖术治疗对抗真菌药物不敏感或病情加重的真菌性角膜炎安全有效。
