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探讨部分板层角膜移植术治疗真菌性角膜炎的手术适应证及临床效果。对临床上确诊为真菌性角膜炎的患者 ,先经常规的抗真菌治疗后 ,选择炎症难以控制病灶位于中浅层的患者共 5 5例 ,用甘油冷冻保存的角膜供体行部分板层角膜移植术 ,对术中取下的病变角膜进行真菌培养、菌属鉴定及病理组织学特点观察。 5 5例中 5 1例治疗真菌感染 ,成功率为 91% ,随访 6～ 18个月 ,植片全部透明 ,矫正视力为 0 .15～ 1.0 ;4例复发 ,复发率为 9% ;46例真菌培养阳性 ,经鉴定为镰刀菌属 33例 ,曲霉菌属 6例 ,念珠菌属 3例 ,青霉菌 1例 ,其他丝状菌属 3例。 5 0例病理切片 PAS染色查见菌丝 ,49例菌丝均未超出病变角膜切片的深度和边缘 ,4例复发者中有一些菌丝已达角膜组织切片的全层 ,菌种为曲霉菌 3例 ,镰刀菌 1例。部分板层角膜移植术是对中浅层真菌性角膜炎具有治疗和复明意义的有效术式之一 ,对溃疡直径较大或偏中心的中浅层真菌性角膜炎可减少术后免疫排斥反应 ,因此更有临床应用价值。
To investigate the surgical indications and clinical effects of some lamellar keratoplasty in the treatment of fungal keratitis. For patients with clinically diagnosed fungal keratitis, routine antifungal therapy was used to select the patients whose inflammation was difficult to control in the superficial layer. In total, 5 cases were treated with glycerol cryopreserved corneal donor for partial lamellar cornea Transplantation, removal of intraoperative lesion corneal fungal culture, identification of bacteria and histopathological features observed. 51 cases of 5 5 cases of fungal infection, the success rate was 91%, followed up for 6 to 18 months, all the transparent graft, corrected visual acuity was 0.15 ~ 1.0; 4 cases of recurrence, the recurrence rate was 9%; 46 cases Fungi culture positive, identified as Fusarium 33 cases, 6 Aspergillus species, Candida 3, penicillium 1, 3 other filamentous bacteria. 50 cases of pathological examination of PAS staining mycelium, 49 cases of myelination did not exceed the depth and edge of the lesion corneal slices, 4 cases of recurrence of some mycelium has reached the full thickness of corneal tissue sections, the strain is Aspergillus 3 cases, 1 case of Fusarium. Part of the lamellar keratoplasty is an effective surgical treatment of the fungal keratitis in the superficial layer and the significance of re-enactment of one of the larger or ulcer diameter of the superficial fungal keratitis can reduce postoperative immunological rejection , So more clinical value.