MODERN APPROACHES TO THE TREATMENT OF CORNEAL ASEPTIC ULCERS
Introduction. Aseptic ulcers of the cornea are among severe, torpid diseases. The aim is to study the etiology and pathogenesis of the corneal aseptic ulcer and determine the tactics of their treatment. Materials and methods. 84 patients (98 eyes) with an aseptic ulcer of the cornea were examined. All patients, in addition to traditional methods of examination, performed optical coherence tomography, determined the area and depth of the ulcer, as well as the lysis activity of the conjunctival fluid. Patients with superficial corneal ulcer defects were treated conservatively in combination with obturation of lacrimal ducts. Patients with deep corneal ulcers performed the closure of the defect with biological tissues (an amniotic membrane, an auto- or allogenic sclera, an autoconjunctival flap “on the pedicle”). The operation was terminated with blepharorraphy or flap coating with a soft contact lens. Results. In all patients with superficial corneal ulcers, it was possible to avoid further progression of the ulcer process and achieve complete epithelialization of the corneal defect. All patients with deep ulcers of the cornea underwent surgical treatment with the closure of a ulcerative defect with a biological tissue. Primarily performed operations were successful at 60 eyes out of 77 (77.9%). In the remaining 17 cases (22.1%), repeated interventions were required. Conclusion. In the treatment of superficial aseptic corneal ulcers, it is useful to combine conservative therapy with the obstruction of lacrimal ducts. All patients with a progressive aseptic ulcer of the cornea need surgical treatment in the form of its coverage with a biological tissue of allo- or autogenous nature. Anterior stromal ulcers should preferably be closed with a free amniotic flap, and the posterior stromal ulcers should be closed with an autoconjunctival flap “on a pedicle” or with a free flap of the sclera. High lytic activity of the tear is the main cause of lysis of biological tissue and a criterion for prescribing local anti-enzyme therapy (bibliography: 6 refs).