應用異體鞏膜移植修補急性角膜潰瘍巨大穿孔

Preserved Scleral Homograft for Corneal Ulcer Complicated with Large Perforation in an Emergency

史敏秀(Min-Hsiu Shih) ； 黃福進(Fu-Chin Huang) ； 林昌平(Chang-Ping Lin)

《中華民國眼科醫學會雜誌》 40卷1期 (2001/03) Pp. 66-72

https://doi.org/10.30048/ACTASOS.200103.0011

摘要

吾人報告四例因進行性角膜潰瘍導致突然之巨大角膜穿孔，合併眼球內容物膨出。在捐贈的眼角膜不能立即取得時，以異體捐贈之鞏膜片(scleral homograft)緊急修補後，雖有部分鞏膜片融蝕(melting)，仍能保持眼球完整性。其中三例在兩星期左右，再施行角膜移植手術。另一例病患拒絕接受二次手術，然在追蹤一年後，雖然鞏膜片邊緣有半透明之變化，仍可維持眼球外型而無眼球穿孔之虞。本文討論以捐贈的鞏膜片替代、修補感染性巨大角膜穿孔之可行性及缺點，在不能立即施行全層角膜移植時，提供另一變通之道。

並列摘要

Corneal ulceration is one of the most frequent causes of blindness in developing country. In dealing with corneal ulceration, corneal perforation is a very emergent complication. Iris prolapse and endophthalmitis could happen via the orifice. Loss of the anterior chamber could result in corneal decompensation and cataract formation. Furthermore, in case of large perforation, loss of the eyeball is inevitable unless undergoing urgent penetrating keratoplasty. However, the source of donor corneas is limited in our country. We used preserved scleral homografts to repair the large perforation in 4 cases of corneal ulceration because the donor corneas were unavailable. After the scleral grafting, three of them underwent the penetrating keratoplasty within 16 days. The fourth case refused further surgical management, and the scleral graft could still remain the tectonic structure after one-year follow up. The benefits and disadvantages were discussed. Two-step transplantation is an alternative choice for treatment of large perforation of corneal ulcer with the following advantages, 1) Elimination of the infection source, 2) remain the eyeball structure, 3) relatively available, 4) possibly decrease the failure rate of following penetrating keratoplasty.

並列關鍵字

corneal ulcer ； scleral homograft ； penetrating keratoplasty