| Objective:We studied the etiology and related risk factors of cornea ulcer with perforation, different kind of surgical treatment and the evaluation of their prognosis.Method: 44 cases of cornea ulcer perforation from January 2003 to December 2008 were collected.There are 10 cases of bacterial corneal ulcer perforation,32 cases of fungal corneal ulcer perforation,1 case of Mooren's ulcer perforation,and 1 case of virus corneal ulcer perforation in the group.All the cases of retrospective analysis were performed. Mechanism and risky factors of different etiology was analyzed. Different ways of surgical treatment were compared and the prognosis was evaluated. Surgical complications and the corresponding principles were explored. Provide clinical experience and improve achievement ratio of surgery.Result: There are 29 cases of penetrating keratoplasty, 1 case of lamellar keratoplasty ,6 cases of conjunctival flap covering surgery ,3 cases of amniotic membrane grafting ,1 case of scleral flap covering surgery combine to trabeculectomy,5 cases of ophthalmectomy in the 44 cases. The vision acuity was increased and for the other 7 no difference was observed. The vision acuity of 22 cases in the 29 cases of penetrating keratoplasty have been improved with varying degrees and 7 cases have no change.The vision acuity of 1 case of lamellar keratoplasty was not changed at all.The vision acuity of 6 patients of conjunctive flap and amniotic membrane grafting was no changed at all. The vision acuity scleral flap covering surgery combine to trabeculectomy increased slightly after when the inflammation subsided. 20 transplants(68.97%) of the 30 cases of keratoplasty were transparent,6 transplants (20.69%) were semi-transparent ,3 transplants(10.34%) was cloudy. 1 case of lamellar keratoplasty was semi-transparent. Adherent leukoma of cornea was found in 3 cases of conjunctive flap.6 patients happened secondary glaucoma after operation,including 4 cases of keratoplasty,1 case of conjunctival flap,and 1 case of amniotic membrane grafting. There were 22 cases occurred in patients with different degrees of coremetamorphosis.8 cases were found complic cataract intraoperative or postoperative in the grape. 3 cases were found anterior chamber hyphema.Transplant rejection was developed in 11(36.7%) patients after keratoplasy and the condition was improved after drug therapy. 1 case was found fungal recurrence after two weeks and it was cured after local and systemic antifungal agents.Conclusion: 1.Of all the causes of the disease, infective cornea ulcer was the most ordinary(43 cases,97.7%). The occurrence of corneal ulcers is because infectious agents (such as bacteria, fungi, viruses, etc.) invade corneal. Fungal infection is the most in the infectious corneal ulcer perforation cases.There are 32 cases(72.7%).Recently the incidence of fungal cornea ulcer increased annually in our country because antibiotics and glucocorticoid were used more and more widely .Fungal keratitis caused by mostly branches and leaves of plants, mostly young and middle-aged men, that is a great impact on society.It should be aroused our attention.2.Identify cause of diagnosis is related to the choice of drug-sensitive antibiotics.It has a great impact on prognosis. Diagnosis of the cause of infective cornea ulcer, namely the identification of the related pathogen was especially important. 3.When the corneal perforation occurred ,the integrity of the eyeball was destructed. Intraocular organization shifting to perforation could cause intraocular structure abnormal. First of all, the purpose of surgery is to restore the integrity of the eyeball.Secondly it to retore the intraocular structure, especially the normal ocular anterior segment structure and it to prevent the occurrence of endo-ophthalmitis. The method of operation includes conjunctive flap, albuginea oculi flap,amniotic membrane transplantation ophthalmectomy and keratoplasty.①penetrating keratoplasty:Penetrating keratoplasty is the most effective treatment to severe corneal ulcer and corneal ulcer perforation. Penetrative keratoplasty was used by replacement of the damaged cornea with healthy and integrit one.It can restore the integrity of the eyeball but also it can restore the transparency of corneal.The effect of penetrating keratoplasty is both clearing the lesions and increasing the vision acuity.②lamellar keratoplasty:Place lamellar corneal to the perforation.This is lamellar keratoplasty.The purpose of lamellar keratoplasty is to repair the perforation and to restore the integrity of the eyeball. Because of the lack of fresh corneal graft in China, lamellar keratoplasty is still meaningful.③conjunctival flap:Conjunctive flap was the method to use autologous conjunctive to cover the perforation of the cornea. Conjunctival flap has rich blood supply and it can enhance local resistance and be good for the healing of the perforation.④amniotic membrane transplantation:Amniotic membrane transplantation was the repairment of the perforation of the cornea with amniotic membrane. The amniotic membrane was tissue derived from human fetus and it was a distinctive biomaterial.It can apply to the treatment of corneal ulcer perforation as a substitute of conjunctiva.⑤scleral flap surgery:It has much merit,such as convenient to gain materials, available result. Albuginea oculi could bear great tension. we must remove necrotic tissue thoroughly and make sure the scleral flap contact the healthy corneal stroma in the surgery.If we sutured closely, the formation of anterior chamber is fast. 6).ophthalmectomy: Cornea ulcer with perforation is a important reason of ophthalmectomy. Most farmers has the poor health situation and little medicine knowledge .In the period of work,they were easy to receive the disease.In the early period,they always are not go to the regular hospital. When they came our hospital,it become a serious entophthalmia. Surgical complications: Transplant rejection that developed after Penetrative keratoplasty was easier than lamellar cornea keratoplasty. It would be treated by drugs at once when Transplant rejection happened and it would cure.To prevent eumycete to recur,we should wash anterior chamber carefully and use drugs after surgical treatmeat. |
PDF Full Text Request