羊膜卷填塞治疗角膜穿孔羊膜的演变及对角膜内皮细胞的影响

目的 观察羊膜卷填塞联合C3F8气体填充治疗角膜穿孔术后羊膜的演变及其对角膜内皮细胞的影响.方法 因各种原因所致角膜穿孔而施行羊膜卷填塞联合前房C3F8气体填充术共56例（56眼）.术中以20％C3F8气体填充前房.术后观察前房深度、房水渗漏情况、气泡维持时间、角膜内皮细胞密度及形态,以及羊膜卷与角膜融合情况.结果 56例角膜穿孔均得到修复,羊膜卷无脱落,术后2个月时羊膜卷与角膜逐渐融合,其间无明显缝隙,C3F8气体在前房存留时间5～16 d,平均（8.2±4.8）d.术前与术后1个月、2个月时角膜内皮细胞密度差异均无统计学意义（t=1.02,1.71,P ＞0.05）,六角形细胞比例术后1个月时低于术前（t=2.13,P＜0.05）,术后1个月与术后2个月时差异无统计学意义（t=1.65,P＞0.05）.结论 羊膜卷填塞联合前房C3F8气体填充可有效修复角膜穿孔,术后羊膜卷与角膜融合好,C3F8气体能较长时间维持前房深度,防止房水渗漏,对角膜内皮细胞影响甚小.

The evolution of amnion and influnce on corneal endothelium in amniotic roll plugging for corneal perforation

Objective To observe the evolution of amnion and influnce on corneal endothelium in amniotic roll plugging combined with C3Fs tamponade in anterior chamber to treat corneal perforation. Methods 56 eyes of 56 patients with corneal perforation accepted the operation of amniotic roll plugging combined with CaF8 tamponade in anterior chamber and the concentration of CaFs gas was 20%. Anterior chamber depth, aqueous leakage, bubbles maintenance time, corneal endothelial cell density and morphology and the fusion of amniotic roll and corneal tissue were observed. Results Corneal perforation of 56 eyes were all repaired without amniotic roll falling off. The fusion of amniotic roll and corneal tissue was observed at 2 months after operation, and the amniotic roll and corneal tissue fused well and no gap was examined. The CaFs gas stayed in the anterior chamber for 5 - 16 days, average of （8.2 ± 4.8） days. There was no significant difference in corneal endothelial cell density between preoperative and postoperative 1 month or 2 month. The percentage of hexagonal cells decreased at postoperative 1 month compared with preoperative （t = 2. 13, P 〉 0. 05 ） , and there was no significant difference between postoperative 1 month and 2 months （ t = 1. 65, P 〉 O. 05 ）. Conclusion Amniotic roll plugging combined with Ca Fs gas tamponade in anterior chamber can effectively repair corneal perforation, and the amniotic roll and cornea can fuse well after operation. Ca Fs gas can stay in the anterior chamber long enough to maintain the anterior chamber depth and prevent leakage of aqueous humor. Little influnce on the corneal endothelium was observed.