Bouazza M, Amine Bensemlali A, Elbelhadji M, Benhmidoune L, El Kabli H, El M'daghri N, Soussi Abdallaoui M, Zaghloul K, Amraoui A
Service d'ophtalmologie adulte, hôpital 20-Août-1953, quartier des hôpitaux, Casablanca, Maroc.
Service d'ophtalmologie adulte, hôpital 20-Août-1953, quartier des hôpitaux, Casablanca, Maroc.
J Fr Ophtalmol. 2015 May;38(5):395-402. doi: 10.1016/j.jfo.2014.11.012. Epub 2015 Apr 16.
The treatment of non-traumatic perforations of the cornea is a real challenge for the choice of surgical technique as well as for management of the causal pathology. The goal of our study is to determine the anatomical and functional results of the management of non-traumatic perforation of the cornea in the absence of ready access to a corneal graft.
This is a retrospective, non-comparative monocentric study of 23 consecutive cases diagnosed and treated between January 2011 and January 2013. We included 23 eyes with non-traumatic corneal perforation. Various surgical techniques were used depending on the size and location of the corneal perforation.
The predominant etiology of the corneal perforations in our series was corneal abscess, found in 30.4% of cases (7 eyes). A conjunctival flap was performed in 43.5% of cases (10 eyes) followed by tarsorrhaphy in 21.7% of cases (5 eyes), autologous corneal patch in 17.4% of cases (4 eyes), amniotic membrane in 13% of cases (3 eyes) and finally cyanoacrylate glue in one case. Mean follow-up was 12.4 ± 2.1 months. Anatomical closure of the corneal perforation was achieved in 91.3% of cases (21 eyes), while the final visual acuity was not improved due to secondary opacities.
The choice of surgical technique depends on the size of the corneal perforation, its location, its etiology and the resources available for emergencies. When amniotic membrane and corneal donor tissue are unavailable, conjunctival flap is an easy and effective technique, which is a good alternative to close corneal perforations less than 3mm. It improves ocular surface quality and prepares the eye for later penetrating keratoplasty.
Conjunctival flap is a good technique that is still relevant today, especially in the absence of corneal donor tissue or amniotic membrane. The anatomical success rate is very satisfactory, but sometimes several interventions are needed to improve the visual prognosis.
对于非创伤性角膜穿孔的治疗而言，手术技术的选择以及病因病理的处理都是一项实实在在的挑战。我们研究的目的是确定在无法立即获取角膜移植的情况下，非创伤性角膜穿孔治疗后的解剖学和功能结果。
这是一项回顾性、非对照的单中心研究，涵盖了2011年1月至2013年1月期间连续诊断和治疗的23例病例。我们纳入了23只患有非创伤性角膜穿孔的眼睛。根据角膜穿孔的大小和位置采用了各种手术技术。
在我们的系列病例中，角膜穿孔的主要病因是角膜脓肿，占病例的30.4%（7只眼）。43.5%的病例（10只眼）进行了结膜瓣遮盖术，21.7%的病例（5只眼）进行了睑裂缝合术，17.4%的病例（4只眼）使用了自体角膜补片，13%的病例（3只眼）使用了羊膜，最后有1例使用了氰基丙烯酸酯胶水。平均随访时间为12.4±2.1个月。91.3%的病例（21只眼）实现了角膜穿孔的解剖学闭合，而由于继发性混浊，最终视力并未改善。
手术技术的选择取决于角膜穿孔的大小、位置、病因以及紧急情况下可用的资源。当羊膜和角膜供体组织无法获取时，结膜瓣遮盖术是一种简便有效的技术，是闭合小于3毫米角膜穿孔的良好替代方法。它可改善眼表质量，并为后续的穿透性角膜移植术做好准备。
结膜瓣遮盖术是一种至今仍适用的良好技术，尤其是在没有角膜供体组织或羊膜的情况下。解剖学成功率非常令人满意，但有时需要多次干预才能改善视力预后。
