POSSIBILITIES FOR COMPREHENSIVE TREATMENT OF PATIENTS WITH TROPHIC CORNEAL ULCER

Abstract

Corneal ulcers of trophic etiology are among its most severe pathologies. Most of them are combined into the so-called category neurotrophic keratopathy, interest in which has increased
significantly in recent years. In order to determine the rational tactics of surgical treatment of such patients, 121 patients who were admitted to the hospital over the past 10 years as an ambulance with a corneal ulcer of trophic origin in 135 eyes were examined at the Ophthalmological Center of the Mariinsky Hospital. All patients were operated on within the first 24 hours after hospitalization. The objective of the operations performed was to completely close the ulcerative defect with biological tissue to restore the integrity of the cornea and create conditions for reparative processes. For these purposes, we used amniotic membrane preserved in a 98% glycerol solution and silicon-dried amniotic membrane, as well as allogeneic sclera. Autologous tissues were also used — sclera and pedicled conjunctival f laps. All tissue coverage of ulcers was combined with either blepharorrhaphy or soft contact lens coverage. The effectiveness of the initial operations was 78.5%. In the remaining 21.5% of cases, repeated interventions were required. As the results of the study showed, for anterior stromal corneal ulcers, covering them with free amnion f laps is most effective. In case of posterior stromal f laps — a pedunculated conjunctival f lap, as well as an allo- or autoscleral f lap with filling of the ulcer with amnion. In the presence of lagophthalmos, it is advisable to simultaneously cover the ulcer with biological tissue, as well as an intervention on the eyelids designed to eliminate lagophthalmos.