【摘要】： 目的 探討重癥化膿性角膜炎手術(shù)治療的療效,評(píng)價(jià)早期及適時(shí)手術(shù)干預(yù)治療化膿性角膜炎的價(jià)值。 方法 對(duì)2006年1月至2009年12月在重慶醫(yī)科大學(xué)附屬第一醫(yī)院眼科住院治療的重癥化膿性角膜炎部分病例進(jìn)行手術(shù)治療。包括細(xì)菌感染35例,真菌感染20例及混合感染6例,共61例(61眼); 7例術(shù)前角膜已穿孔,18例前房積膿超過(guò)1/3;手術(shù)方式:穿透性角膜移植(PKP)46例,板層角膜移植(LKP)8例,其它手術(shù)7例。隨訪3-12個(gè)月,觀察眼球保存情況、術(shù)后視力變化、感染復(fù)發(fā)及其并發(fā)癥。 結(jié)果 1.術(shù)后56例成功保住眼球,4例摘除眼球,1例失訪; 2.術(shù)前78.7%(48例)視力小于0.02,其中有一半以上是僅有手動(dòng)甚至光感視力,術(shù)后絕大部分視力有提高,51.8%(29例)視力大于0.02,有13例術(shù)后視力大于0.1; 3.感染復(fù)發(fā)6例,其中3例藥物治療無(wú)效、病情進(jìn)展極快最終摘除了眼球,3例再次手術(shù)后保住眼球; 4.繼發(fā)性青光眼7例,6例用藥后眼壓控制良好,1例因視功能喪失伴劇痛后摘除眼球;并發(fā)性白內(nèi)障15例; 5.排斥反應(yīng)17例, 3例行二次手術(shù)后穩(wěn)定,1例因排斥放棄治療。 結(jié)論 1、手術(shù)是治療重癥化膿性角膜炎的有效方式,其中主要是角膜移植特別是PKP對(duì)挽救重癥角膜炎患者眼球,改善視功能有重要作用。 2、對(duì)重癥化膿性角膜炎早期及適時(shí)進(jìn)行手術(shù)治療,大部分患者能挽救眼球,并不同程度的提高視力。 3、在角膜穿孔較小而無(wú)合適角膜材料情況下,用結(jié)膜瓣遮蓋或羊膜移植(AMT)可以修復(fù)潰瘍,為二次行光學(xué)性治療創(chuàng)造條件。
[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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類(lèi)號(hào)】：R779.6

【參考文獻(xiàn)】

相關(guān)期刊論文 前6條

1 孫旭光;細(xì)菌性角膜炎診治進(jìn)展[J];中國(guó)醫(yī)刊;2003年06期

2 張文華,潘志強(qiáng),王智群,金秀英,羅士運(yùn),鄒洋,武宇影,李然;化膿性角膜潰瘍常見(jiàn)致病菌的變遷[J];中華眼科雜志;2002年01期

3 史偉云,李紹偉,謝立信;板層角膜移植術(shù)治療真菌性角膜炎的臨床療效分析[J];中華眼科雜志;2002年06期

4 謝立信,翟華蕾;穿透性角膜移植術(shù)治療真菌性角膜潰瘍穿孔[J];中華眼科雜志;2005年11期

5 徐楠;鄒豪;溫海;陳江漢;;攜兩性霉素B的聚氰基丙烯酸正丁酯納米粒對(duì)大鼠肝腎功能及血液系統(tǒng)的影響[J];中國(guó)真菌學(xué)雜志;2007年01期

6 徐楠;鄒豪;溫海;徐紅;仇蕓;趙謹(jǐn);陳江漢;;兩性霉素B聚氰基丙烯酸正丁酯納米粒跨血腦屏障及抗隱球菌效力的研究[J];中國(guó)生物醫(yī)學(xué)工程學(xué)報(bào);2009年02期

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