Résumé
Objective To investigate the mierotechnique of bilayer amniotic membrane transplantation for treatment of Mooren's ulcer and evaluate the efficacy. Methods Six patients (6 eyes) with Mooren's ulcer were recruited for this study. After medical treatment or lameilar keratoplasty failed to arrest progress of corneal ulcer, bilayer amniotic membrane transplantation was performed for the treatment. We investigated the integrity of corneal epithelium, the healing of corneal ulcer, the improvement of stromal edema, the atrophy of neovessels, the transformation of amniotic membrane and the occurrence of relapse. Results All patients were followed up for 24-34 months (mean 30 months). In all cases, superficial anmiotic membrane dissolved or shed on postoperative day 7-11, disconnecting now. Corneal ulcer healed within 7-15 days postoperatively. In 5 eyes, corneal stromal edema faded away within 2-3 weeks. Corneal neovessels regressed within 2-3 months. The deeper grafts were adhered into the ulcer and fused with the cornea 3 months after the operation. Corneal transparence or macula was achieved within 5-8 months. No recurrence of Moorcn's ulcer was oc-curred in 4 patients during the follow-up period, while 2 eyes relapsed for the exposure of sutures and not re-moving the stitches timely, which had been treated with lamellar keratoplasty and no recurrence again during the follow-up period. Conclusion Bilayer amniotic membrane transplantation has advantages for Mooren's ulcer treatment. Mastering the microsurgical techniques and removing the stitches timely are the key to the success of surgery. It also provides good conditions for the further conduct of keratoplasty.
Résumé
Objective To explore the clinical efficacy of modified corneal ulcer debridement combining with anti-fungal agents in the treatment of keratomycosis(fungal corneal ulcer).Design Prospective case series.Participants Criteria for inclusion:1)fungal corneal ulcer was diagnosed under direct 10% KOH wet film microscopic examination;2)corneal ulcer located away from the center with superficial infiltration,or located in the center but in small size;3)depth of corneal infiltration was uncertain.From January,2007 to December,2009,141 cases of fungal corneal ulcer patients in Shandong Eye Institute affiliated to Qingdao Eye Hospital were recruited into this study.Methods All patients received modified corneal ulcer debridement including stripping off ulcer lesion as well as infiltrated tissue,and repairing ulcer fringe.For postoperative treatment,0.25% amphotercin B or 5% natamycin and 0.5% fluconazol eye drops were topically administrated with high frequency to the diseased eye.In the meantime,itraconalzole was orally taken as systematic treatment.Clinical efficacy of the above therapy was evaluated at last.Main Outcome Measurs Corneal ulcer infiltration,corneal epithelium reparation and recovery of vision acuity were closely observed following surgery.Results 10% KOH wet film examination showed that hypha was found in all of the 141 cases.The average time for postoperative follow-up was 29 days(from 14 to 60 days).All 141 cases of fungal corneal ulcer were completely healed,of which 127 cases were healed by taking corneal ulcer debridement surgery and anti-fungal medication,and the other 14 cases had to take penetrating keratoplasty(10 cases) or lameller keratoplasty(4 cases) due to uncontrolled infection.No recurrence was found during follow-up.The average time for healing in the 127 cases was 8.5 days,and among these cases,29 cases had a preoperative visual acuity below 0.05,80 cases between 0.05 and 0.3,and 32 cases between 0.3 and 1.0.Postoperative evaluation showed that 6 cases had a visual acuity below 0.05,42 cases between 0.05 and 0.3,93 cases(65.96%) between 0.3 and 1.0,and among 93 cases,81 cases(57.45%) had a visual acuity between 0.5 and 1.0.Conclusions The modified corneal ulcer debridement combining with anti-fungal agents has proved to be an effective treatment for fungal corneal ulcer.It greatly improves patient's visual acuity and shortens the disease duration.For cases of superficial or uncertain infiltration,corneal ulcer debridement enables better ulcer observation and provides guidance for further treatment.