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目的探讨应用改良结膜瓣遮盖术治疗重症真菌性角膜溃疡的临床效果。方法选择感染基本控制的重症真菌性角膜溃疡58例(58眼),其中角膜穿孔10例。手术中角膜溃疡面清创,4%碘酊烧灼溃疡面,在临近角膜溃疡处做带眼球筋膜囊组织的单蒂结膜瓣遮盖于表面,间断固定缝合。结果55例术后一次成功,3例结膜瓣溶解脱落,手术一次成功率94.83%。其中10例角膜穿孔眼手术均一次成功,感染全部控制,但是有2眼术后发生继发性青光眼。结论改良结膜瓣遮盖手术在治疗重症真菌性角膜溃疡中能有效地控制感染,保存眼球,尤其是对穿孔或近穿孔而无条件进行角膜移植的患者可控制病情,为下一步复明手术打下基础。
Objective To investigate the clinical effect of modified conjunctival flap occlusion in the treatment of severe fungal corneal ulcer. Methods Fifty-eight cases (58 eyes) of severe fungal corneal ulcer were selected for infection control, including 10 cases of corneal perforation. Surgical corneal ulcer surface debridement, 4% iodine tincture burning ulcer surface, adjacent to the corneal ulcer at the Department of ocular fascia tissue monolayer conjunctival flap covering the surface, intermittent fixed suture. Results 55 cases were successfully treated at one time. Three conjunctival flaps were dissolved and detached. The success rate of one operation was 94.83%. Among them, 10 cases of corneal perforation were operated successfully and all the infections were controlled. However, there were 2 cases of secondary glaucoma after operation. Conclusion The modified conjunctival flap masking surgery can effectively control infection and preserve the eyeball in the treatment of severe fungal corneal ulcer. Especially in perforation or near perforation patients who can undergo corneal transplantation can control the disease and lay the foundation for the next surgery.