探讨应用纤维蛋白胶粘合多层角膜基质透镜治疗真菌性角膜溃疡并发穿孔的疗效。

选取5只(5只眼)成年新西兰大白兔左眼角膜接种烟曲霉菌制作实验性角膜溃疡并发穿孔模型。采用全飞秒激光行角膜屈光术，收集角膜基质透镜，并使用纤维蛋白胶将其粘合制成角膜基质植片。使用适当大小的环钻钻取该角膜基质植片的中央部分，并使用10-0尼龙线将钻取部分连续缝合于角膜植床。术后配戴治疗性角膜接触镜(绷带镜)。术后局部使用那他霉素滴眼液点眼，1次/2 h；左氧氟沙星滴眼液点眼，4次/d，治疗1个月，随访观察3个月。记录新西兰大白兔术后3 d、7 d、1个月及3个月角膜溃疡愈合、角膜透明、排斥反应及角膜移植区新生血管生长的情况。实验资料使用频数和百分比进行描述。

5只实验性兔眼角膜接种烟曲霉菌10 d后，可见角膜穿孔灶，全部出现真菌性角膜溃疡并发穿孔。经角膜共聚焦显微镜检查见菌丝或角膜刮片镜检见菌丝。术后3 d，有5只眼角膜植片水肿，未出现上皮排斥线、基质浸润及内皮排斥线，占100%(5/5)；有4只眼角膜植片上皮未完全修复，占80%(4/5)；有1只眼植片上皮愈合，占20%(1/5)；无新生血管形成；无角膜植片浸润。术后7 d，有2只眼角膜植片上皮愈合，占40%(2/5)；有3只眼植片中央区上皮未修复，占60%(3/5)。术后1个月，5只眼植片透明，水肿消失，未出现上皮及内皮排斥线，角膜后沉着物；1只眼上方新生血管形成。对有新生血管形成眼使用氯霉素滴眼液点眼，1~2滴/次，3~5次/d，治疗后瘢痕血管化愈合，经角膜共聚焦显微镜复查未发现菌丝，上皮愈合。术后3个月，5只眼角膜植片透明，未出现排斥反应，角膜基质植片在位平整，轻度混浊，无角膜血管翳，占100%(5/5)。角膜基质植片术后上皮再生时间是(16±2)d。

应用纤维蛋白胶粘合多层角膜基质透镜组成角膜基质植片能成功治愈新西兰大白兔真菌性角膜溃疡并发穿孔，为临床角膜溃疡并发穿孔性疾病的治疗提供了潜在方案。

The aim of this study was to explore the therapeutic effect of multi-layer corneal matrix lens implant in the treatment of fungal corneal ulcer complicated with perforation.

The experimental models of corneal ulcer complicated with perforation was built on 5 adult New Zealand white rabbits. The corneal stroma lenticule was collected with femtosecond laser small incision lenticule extraction and bonded with fibrin glue to form a corneal stroma graft. The central part of the corneal stroma graft was drilled with a trephine of appropriate size as a graft, and the graft was used for 10-0 Nylon thread was continuously sutured to the corneal implant bed. After operation, therapeutic contact lens (bandage lens) was worn, and receiving natamycin eye drops one time every 2 hours, levofloxacin eye drops 4 times per day, for 1 month, following up to 3 months. The results of corneal ulcer healing, corneal transparency, reject reaction, and neovascularization growth in corneal stromal grafts after surgery for 3 days, 7 days, 1 month and 3 months were observed. The data were described by using frequency and percentage.

Fungal corneal ulcer occurred in the cornea after 10 days of inoculating Aspergillus fumigatus. Hyphae were found by corneal confocal microscopy or corneal scraping under direct microscopy. After inoculating for 3 days, 5 eyes had corneal graft edema, and no epithelial rejection line, stroma infiltration, or endothelial rejection line appeared, accounting for 100% (5/5) ; 4 eyes corneal graft epithelium was not completely repaired, accounting for 80% (4/5) and 1 eye of the epithelium of the graft was healed, accounting for 20% (1/5); there was no neovascularization; there was no corneal graft infiltration. At 7 days postoperatively, 2 eyes corneal graft epithelial healing, accounting for 40% (2/5); 3 eyes of the epithelium in the central area of the graft was not repaired, accounting for 60% (3/5). After inoculating for one month, 5 eyes had transparent grafts, edema disappeared, no epithelial and endothelial rejection lines, retrocorneal deposits appeared, accounting for 100% (5/5); 1 eye had neovascularization, accounting for 20% (1/5). The chloramphenicol eye drops in conjunctival sac was applied for neovascular eyes 1 to 2 drops every time, 3 to 5 times per day; after treatment the scar was finally healed by vascularization, and no hyphae was found by corneal confocal microscope. After 3 months, 5 eyes of the corneal grafts were transparent, and no rejection occurred, mildly turbid, and no pannus, accounting for 100% (5/5). The time of epithelial regeneration after the corneal stromal grafts transplantation surgery was (16±2) d.

In this study, fibrin glue and multi-layered corneal stromal lens were used to successfully cure the fungal corneal ulcer of white rabbit, which to provide concurrent clinical corneal ulcer perforation disease with potential therapies.