Sun Yi-Chen, Kam Jason P, Shen Tueng T
Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.
Department of Ophthalmology, University of Washington, Seattle, WA, USA.
Tzu Chi Med J. 2018 Jan-Mar;30(1):24-28. doi: 10.4103/tcmj.tcmj_191_17.
Appropriate management of nontraumatic acute corneal perforation is always a challenge even with the many advances in surgical materials and techniques. We reported the outcomes of a case series of acute corneal perforation repair using a newly modified conjunctival flap with amniotic membrane transplant (AMT), fibrin glue, and a bandage soft contact lens (BCL).
A total of 13 consecutive referral cases with nontraumatic acute corneal perforation at the University of Washington were reviewed. All open globes were repaired by a combined surgery with a modified conjunctival flap, AMT, fibrin glue, and BCL. Visual acuity, a slit lamp examination, and the patient-reported pain level were collected preoperatively and postoperatively. Subsequent corneal surgeries to improve visual function were also reviewed.
All ocular surfaces of the 13 eyes were stable at postoperative follow-up. Eleven of the 13 patients had the same or worse visual acuity 1 week postoperatively. Nine of the 13 patients achieved better vision 6 months postoperatively. None of the patients developed perioperative or postoperative complications. Five patients with good visual potential underwent further corneal surgeries, including Boston keratoprosthesis and penetrating keratoplasty. The average referral distance was 217 miles and the median number of follow-up visits within 6 months was 4.
The combination of a modified conjunctival flap, AMT, fibrin glue, and a BCL could provide a temporary method to stabilize and secure the integrity of the globe as well as the ocular surface after a nontraumatic acute corneal perforation. This approach allows easy follow-up and preserves the eye for future corneal surgery under optimal conditions.
即使手术材料和技术有了诸多进展，非创伤性急性角膜穿孔的恰当处理始终是一项挑战。我们报告了一系列使用新改良的结膜瓣联合羊膜移植（AMT）、纤维蛋白胶和绷带软性接触镜（BCL）修复急性角膜穿孔的病例结果。
回顾了华盛顿大学连续收治的13例非创伤性急性角膜穿孔转诊病例。所有开放性眼球均通过联合手术进行修复，手术采用改良结膜瓣、AMT、纤维蛋白胶和BCL。术前和术后收集视力、裂隙灯检查结果以及患者报告的疼痛程度。还回顾了后续为改善视功能而进行的角膜手术。
术后随访时，13只眼的所有眼表均保持稳定。13例患者中有11例术后1周视力相同或更差。13例患者中有9例术后6个月视力改善。所有患者均未发生围手术期或术后并发症。5例具有良好视力潜力的患者接受了进一步的角膜手术，包括波士顿人工角膜和穿透性角膜移植术。平均转诊距离为217英里，6个月内随访就诊的中位数为4次。
改良结膜瓣、AMT、纤维蛋白胶和BCL的联合应用可为非创伤性急性角膜穿孔后稳定并确保眼球及眼表的完整性提供一种临时方法。这种方法便于随访，并能在最佳条件下为未来的角膜手术保留眼球。
