The Use Of Conjunctival Flap Covering Surgery In The Treatment Of Refractory Keratitis

Objective To study the curative effect of conjunctival flap covering surgery in treatment of refractory keratitis.Methods This is a retrospective study which review the case records of 161 patients with refractory keratitis undergone conjunctival flaps.Those diseases included 118 cases with infective corneal ulcer(71 cases with fungal corneal ulcer,16 cases of bacterial corneal ulcer,31 cases with herpes virus corneal ulcer)and 43 cases with non-infective corneal diseases(22 cases with bullous keratopathy,6 cases with neurotrophic keratitis,10 cases with corneal keatoplasty ulcer,5 cases with extraction of foreign bodies in deep layers of cornea).The medical treatment for the primary disease were continued in postoperative period,and the follow-up visit ranged from 3 to 106 months were observed for the evaluation of curative effect.Results141 of 161 cases were healed and the cure rate was 87.6%.Among them,the cure rate of infective corneal ulcer(99/118),fungal keratitis(54/71),bacterial keratitis(15/16),herpes simplex keratitis(30/31)and non-infective corneal diseases(42/43)were 83.9%,76.1%,93.8%,96.8% and 97.7% respectively.Significant differences were observed regarding the success rate(P<0.05)between the infective and non-infective corneal diseases,and the non-infective corneal diseases were outstanding.In infective keratitis,the curative effect of herpes simplex keratitis was better than fungal and bacterial corneal ulcer(P<0.05).The complications were found in 21 cases with partial dissolution(11 cases),perforation(4 cases),retraction(4 cases)of the flaps and secondary glaucoma(2 cases).There were 20 cases of postoperative complications in infectious corneal ulcer(incidence rate 16.9%)and 1 case in non infectious corneal diseases(incidence rate 2.3%).The difference was statistically significant(P<0.05)compared between infectious corneal ulcer and non-infectious corneal diseases,and the complication incidence of non-infectious corneal diseases was far lower than infectious corneal keratitis.Conclusions Conjunctival flap covering surgery is an effective way in treatment of various refractory corneal diseases.The curative effect of non-infective keratitis is better than infectious corneal disease.For acute pyogenic corneal ulcer,the preoperative medical treatment is helpful to improve the operation success rate.