重症化脓性角膜炎手术治疗的临床分析
发布时间：2019-01-25 08:55
【摘要】： 目的 探讨重症化脓性角膜炎手术治疗的疗效,评价早期及适时手术干预治疗化脓性角膜炎的价值。 方法 对2006年1月至2009年12月在重庆医科大学附属第一医院眼科住院治疗的重症化脓性角膜炎部分病例进行手术治疗。包括细菌感染35例,真菌感染20例及混合感染6例,共61例(61眼); 7例术前角膜已穿孔,18例前房积脓超过1/3;手术方式:穿透性角膜移植(PKP)46例,板层角膜移植(LKP)8例,其它手术7例。随访3-12个月,观察眼球保存情况、术后视力变化、感染复发及其并发症。 结果 1.术后56例成功保住眼球,4例摘除眼球,1例失访; 2.术前78.7%(48例)视力小于0.02,其中有一半以上是仅有手动甚至光感视力,术后绝大部分视力有提高,51.8%(29例)视力大于0.02,有13例术后视力大于0.1; 3.感染复发6例,其中3例药物治疗无效、病情进展极快最终摘除了眼球,3例再次手术后保住眼球; 4.继发性青光眼7例,6例用药后眼压控制良好,1例因视功能丧失伴剧痛后摘除眼球;并发性白内障15例; 5.排斥反应17例, 3例行二次手术后稳定,1例因排斥放弃治疗。 结论 1、手术是治疗重症化脓性角膜炎的有效方式,其中主要是角膜移植特别是PKP对挽救重症角膜炎患者眼球,改善视功能有重要作用。 2、对重症化脓性角膜炎早期及适时进行手术治疗,大部分患者能挽救眼球,并不同程度的提高视力。 3、在角膜穿孔较小而无合适角膜材料情况下,用结膜瓣遮盖或羊膜移植(AMT)可以修复溃疡,为二次行光学性治疗创造条件。
[Abstract]:Objective to evaluate the value of early and timely surgical intervention in the treatment of severe suppurative keratitis. Methods from January 2006 to December 2009, some cases of severe suppurative keratitis who were hospitalized in the first affiliated Hospital of Chongqing Medical University were operated on. It included bacterial infection in 35 cases, fungal infection in 20 cases and mixed infection in 6 cases (61 eyes). The operative methods: penetrating keratoplasty (PKP) in 46 cases, lamellar keratoplasty (LKP) in 8 cases, and other operations in 7 cases. Patients were followed up for 3-12 months to observe eyeball preservation, postoperative visual acuity, recurrence of infection and complications. Result 1. After operation, 56 cases were successfully saved eyeball, 4 cases were extirpated, 1 case was lost; 2. The visual acuity was less than 0.02 in 48 cases (78.7%) before operation. More than half of them had only manual or even light visual acuity. The majority of the visual acuity was improved after operation, and the visual acuity of 51.8% (29 cases) was better than 0.02. Postoperative visual acuity was greater than 0.1 in 13 cases. 3. Infection recurred in 6 cases, of which 3 cases failed to be treated with drugs, and the eyeball was removed at the end of the rapid progress of the disease, and the eyeball was preserved in 3 cases after reoperation. 4. 7 cases of secondary glaucoma, 6 cases of good intraocular pressure control, 1 case of loss of visual function with severe pain after extirpation of eyeball, 15 cases of complicated cataract, 5 cases. In 17 cases of rejection, 3 cases were stable after secondary operation, and 1 case gave up treatment because of rejection. Conclusion 1. Surgery is an effective method for the treatment of severe suppurative keratitis. Corneal transplantation, especially PKP, plays an important role in saving the eyeball and improving the visual function of the patients with severe keratitis. 2, early and timely surgical treatment for severe suppurative keratitis, most patients can save eyeball and improve eyesight differently. 3. In the case of small corneal perforation and no suitable corneal material, conjunctival flap covering or amniotic membrane transplantation (AMT) can repair ulcers and create conditions for secondary optical therapy.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.6
本文编号：2414987
[Abstract]:Objective to evaluate the value of early and timely surgical intervention in the treatment of severe suppurative keratitis. Methods from January 2006 to December 2009, some cases of severe suppurative keratitis who were hospitalized in the first affiliated Hospital of Chongqing Medical University were operated on. It included bacterial infection in 35 cases, fungal infection in 20 cases and mixed infection in 6 cases (61 eyes). The operative methods: penetrating keratoplasty (PKP) in 46 cases, lamellar keratoplasty (LKP) in 8 cases, and other operations in 7 cases. Patients were followed up for 3-12 months to observe eyeball preservation, postoperative visual acuity, recurrence of infection and complications. Result 1. After operation, 56 cases were successfully saved eyeball, 4 cases were extirpated, 1 case was lost; 2. The visual acuity was less than 0.02 in 48 cases (78.7%) before operation. More than half of them had only manual or even light visual acuity. The majority of the visual acuity was improved after operation, and the visual acuity of 51.8% (29 cases) was better than 0.02. Postoperative visual acuity was greater than 0.1 in 13 cases. 3. Infection recurred in 6 cases, of which 3 cases failed to be treated with drugs, and the eyeball was removed at the end of the rapid progress of the disease, and the eyeball was preserved in 3 cases after reoperation. 4. 7 cases of secondary glaucoma, 6 cases of good intraocular pressure control, 1 case of loss of visual function with severe pain after extirpation of eyeball, 15 cases of complicated cataract, 5 cases. In 17 cases of rejection, 3 cases were stable after secondary operation, and 1 case gave up treatment because of rejection. Conclusion 1. Surgery is an effective method for the treatment of severe suppurative keratitis. Corneal transplantation, especially PKP, plays an important role in saving the eyeball and improving the visual function of the patients with severe keratitis. 2, early and timely surgical treatment for severe suppurative keratitis, most patients can save eyeball and improve eyesight differently. 3. In the case of small corneal perforation and no suitable corneal material, conjunctival flap covering or amniotic membrane transplantation (AMT) can repair ulcers and create conditions for secondary optical therapy.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.6
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