Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
Br J Ophthalmol. 2019 Apr;103(4):530-533. doi: 10.1136/bjophthalmol-2018-312375. Epub 2018 May 29.
To describe the clinical features and management of corneal fistula in patients of healed keratitis.
Medical records of all patients of healed keratitis presenting to the cornea clinic from November 2016 to September 2017 were reviewed. Eightcases of corneal fistula (six true fistulas, two closed fistulas) were identified. Six patients were managed with autologous tenon patch graft while two patients were managed medically. Various risk factors and treatment outcomes of corneal fistulisation were evaluated.
The patients included two patients of failed therapeutic keratoplasty (with resolved graft infection) and six patients of healed keratitis. The age of the patients ranged between 10 and 60 years. Five of the patients were male while three were female. The size of the fistula measured between 1 and 2 mm. A surrounding cystic area of diameter ranging between 1 and 4.5 mm was seen in all the patients. In all of the patients, the treating physician missed the diagnosis. Complete healing was noted at 6-8 weeks in all the patients who underwent tenon graft. One patient refused to undergo any surgery and was lost to follow-up. In another case, surgery was deferred due to uncontrolled hypertension and he developed anterior staphyloma subsequently.
Corneal fistula can often be missed in an apparently healed perforated corneal ulcer. Tenon patch graft is an effective technique for the management of corneal fistula.
描述愈合性角膜炎患者的角膜瘘的临床特征和处理方法。
回顾了 2016 年 11 月至 2017 年 9 月期间在角膜诊所就诊的所有愈合性角膜炎患者的病历。共发现 8 例角膜瘘（6 例真性瘘，2 例闭合性瘘）。6 例患者采用自体筋膜移植片治疗，2 例患者采用药物治疗。评估了角膜瘘形成的各种危险因素和治疗结果。
患者包括 2 例治疗性角膜移植失败（合并移植感染已解决）和 6 例愈合性角膜炎。患者年龄在 10 至 60 岁之间，男性 5 例，女性 3 例。瘘的大小在 1 至 2mm 之间。所有患者均可见直径在 1 至 4.5mm 之间的周围囊性区域。所有患者均被漏诊。所有接受筋膜移植的患者在 6-8 周内均完全愈合。1 例患者拒绝手术，失访。另 1 例因高血压未得到控制而推迟手术，随后发生前葡萄肿。
在明显愈合的穿孔性角膜溃疡中，角膜瘘常常会被漏诊。筋膜移植片是治疗角膜瘘的有效方法。
