Zhong Jing, Wang Bowen, Li Saiqun, Deng Yuqing, Huang Haixiang, Chen Ling, Yuan Jin
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong 510060, P.R. China.
Exp Ther Med. 2018 Mar;15(3):2711-2718. doi: 10.3892/etm.2018.5765. Epub 2018 Jan 17.
Fungal keratitis is a severe and common ocular infectious disease. The present study evaluated the efficiency of full-thickness conjunctival flap covering surgery with amniotic membrane transplantation (FCCS + AMT) as a transitional surgery for severe fungal keratitis. A total of 17 patients with severe fungal keratitis without corneal perforation underwent FCCS + AMT between January 2010 and December 2015. The pathogenic factors, preoperative diagnosis and postoperative prognosis of FCCS + AMT at 3 months were evaluated. Subsequently, 7 patients received sclerokeratoplasty, and the best-corrected visual acuity (BCVA) and recurrence ratio were analyzed at 1 month postoperatively. The primary risk factor was agricultural trauma (7 cases), followed by a non-agricultural object entering the eye (3 cases). Preoperatively, there were 10 cases of fungal keratitis positively identified using confocal microscopy and 9 cases positively identified by corneal scrapings. A total of 3 months following FCCS + AMT, the percentage of cases resulting in preservation of the eyeball was 88.24%, with 15/17 patients demonstrating complete conjunctival re-epithelization and a smooth conjunctival surface without any complications. A total of 2 (11.76%) patients experienced melting of the conjunctival flap and development of endophthalmitis, and subsequently underwent ocular evisceration surgery. A total of 7 patients underwent sclerokeratoplasty and the mean logarithm of the minimum angle of resolution BCVA at 1 month was significantly improved (0.689±0.121; P<0.001) compared with preoperative values (2.459±0.037) and BCVA values following FCCS + AMT (2.529±0.066). No recurrence was observed in any of the cases during the follow-up period. Conclusively, FCCS + AMT may be a preferable treatment for severe fungal keratitis of the entire corneal ulcer without perforation, and may save the eyeball and provide a greater opportunity for corneal transplantation.
真菌性角膜炎是一种严重且常见的眼部感染性疾病。本研究评估了全层结膜瓣覆盖联合羊膜移植手术（FCCS + AMT）作为重度真菌性角膜炎过渡性手术的疗效。2010年1月至2015年12月期间，共有17例无角膜穿孔的重度真菌性角膜炎患者接受了FCCS + AMT手术。对FCCS + AMT术后3个月的致病因素、术前诊断及预后进行了评估。随后，7例患者接受了巩膜角膜移植术，并对术后1个月的最佳矫正视力（BCVA）和复发率进行了分析。主要危险因素为农业外伤（7例），其次是非农业物体入眼（3例）。术前，共10例真菌性角膜炎经共聚焦显微镜检查确诊，9例经角膜刮片确诊。FCCS + AMT术后3个月，眼球保留率为88.24%，17例患者中有15例结膜完全重新上皮化，结膜表面光滑，无任何并发症。共有2例（11.76%）患者出现结膜瓣溶解并发生眼内炎，随后接受了眼球摘除术。共有7例患者接受了巩膜角膜移植术，术后1个月平均最小分辨角对数视力（BCVA）较术前值（2.459±0.037）及FCCS + AMT术后BCVA值（2.529±0.066）显著提高（0.689±0.121；P<0.001）。随访期间所有病例均未观察到复发。总之，FCCS + AMT可能是治疗非穿孔性全角膜溃疡重度真菌性角膜炎的一种较好方法，可挽救眼球并为角膜移植提供更大机会。
