Microsurgical approach to the conjunctival flap
Microsurgical approach to the conjunctival flap
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DOI：
10.1001/archopht.121.8.1189
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发表时间：
2003-08-01
影响因子：
--
通讯作者：
Quinter, AP
中科院分区：
文献类型：
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作者：
Khodadoust, A;Quinter, AP
目的：描述一种选择性带蒂结膜瓣显微手术方法治疗慢性角膜溃疡伴或不伴角膜穿孔，并提供50例连续病例的结果。设计：回顾性、非比较性病例系列和病例报告。患者：1982年至1996年间，在康涅狄格州接受显微结膜瓣手术治疗慢性角膜溃疡的所有患者均接受了Eyecare Center，New Haven.Interventions：Partial pedunculated conjunctival flap surgery.Methods：Review of the initial ocular diagnosis and characteristics as well as the retrospective study of the postoperative course.Main Outcome Measures：Resolution of the corneal ulcer and postoperative stability of conjunctival flap.Results：62% of the corneal ulcer treated were nonperforated，and 38% were perforated.诊断包括单纯疱疹病毒（14例）、细菌性溃疡（11例）、类风湿性关节炎（8例）、无晶状体大泡性角膜病变（6例）、移植排斥（4例）、带状疱疹病毒（5例）和其他（2例）。术后94%的结膜瓣稳定，3%失败。64%的病例为确定性手术，36%为临时性手术; 61%的患者在术后6至24个月接受了角膜移植，38%的患者在原始病变愈合后6至12个月摘除了角膜瓣。选择性带蒂结膜瓣是一种有效和实用的手术方法来治疗穿孔和非穿孔性角膜溃疡，对其他类型的药物治疗没有反应。
Objectives: To describe a microsurgical approach to a selective pedunculated conjunctival flap for the treatment of chronic corneal ulceration with or without corneal perforation, and to present the results of 50 consecutive cases.Design: Retrospective, noncomparative case series and case reports.Patients: All patients who had microsurgical conjunctival flap procedures for the treatment of chronic corneal ulcers between 1982 and 1996 at the Connecticut Eyecare Center, New Haven.Interventions: Partial pedunculated conjunctival flap surgery.Methods: Review of the initial ocular diagnoses and characteristics as well as retrospective study of the postoperative course.Main Outcome Measures: Resolution of the corneal ulcer and postoperative stability of the conjunctival flap.Results: Sixty-two percent of the corneal ulcers treated were nonperforated, and 38% were perforated. The diagnoses included herpes simplex virus (14 patients), bacterial ulcer (11 patients), rheumatoid arthritis (8 patients), aphakic bullous keratopathy (6 patients), graft rejection (4 patients), herpes zoster virus (5 patients), and other (2 patients). Postoperatively, 94% of the conjunctival flaps were stable, and 3% had failed. The procedures were definitive in 64% of cases and temporary in 36%; 61% of patients received a corneal transplant 6 to 24 months postoperatively, and in 38% the flaps were removed 6 to 12 months after the original lesion had healed.Conclusion: A selective pedunculated conjunctival flap is an effective and practical surgical approach to the treatment of perforated and nonperforated corneal ulcers that have not responded to other types of medical therapy.