| Objective: to study the etiology and related risk factors of cornea ulcer with perforation, different kind of clinical treatment and the evaluation of their prognosis.Method: 49 cases of cornea ulcer perforation from January 1993 to June 2003 were collected and retrospective analysis performed. Mechanism and risky factors of different etiology was analyzed. Different ways of clinical treatment were compared and the prognosis evaluated.Result: In 16 of the 49 cases, the ulcers were healed after simple drug therapy. In 33, the ulcers were healed after the combined therapy of drug and surgery. For 6 of the 16 cases of simple drug therapy, the vision acuity was increased and for the other 10, the vision acuity was not significantly improved or decreased a little. For 17 of the 22 cases of penetrative cornea transplantation, the vision acuity was increased and for the other 5 no difference was observed. The vision acuity of 2 patients of lamellar cornea transplantation was not changed at all. The vision acuity of 2 patients of conjunctive flap was not changed at all. 18 transplants of the 24 cases of keratoplasty were transparent, 5 were semi-transparent, 1 was cloudy. Adherent leukoma of cornea was found in 13 of the cases of simple drug therapy and 3 cases of conjunctive flap. Simple leukoma of cornea were found in 3 cases of simple drug therapy. Glaucoma was developed for 2 cases after operation and glaucoma decompression was performed. Transplant rejection was developed in 6 patients after keratoplasy and the condition was improved after drug therapy. No recurrence of ulcer was found for all the cases afte 6-12 months of follow-up.Conclusion: Of all the causes of the disease, infective cornea ulcer was the most ordinary, the reason of which is as follows: 1) the external invasion of infective factors was the most common reason for the ulcer of cornea; 2) the ongoing of perforation after the infection of cornea was related to many factors namely 2: (1) the cornea ulcer was treated correctly and duly; (2) the damage caused by the infective factors is severe or not. Recently with the development of antibiotics, especially the wide application of wide-spectrum antibiotics, the number of drug resistant strains of bacteria increased a lot. Besides, pseudomonas aeruginosa was very virulent and they can produce a kind of proteinase, which can degrade the gelatin fibers of the cornea. The cornea will be destroyed in a very short period of time and perforation will occur in 2-3 days. Recently the incidence of fungal cornea ulcer increased annually in our country and it was always misdiagnosed because of it varied clinical symptoms. And usually this disease was not treated duly because of the lack of sensitive anti-fungal drugs. Perforation will ensue at last. Viral infections were very common and they were difficult to treat because they are ready to relapse. The occurrence of viral infection was not related with the health of the host and perforation always ensued. Amoebic cornea ulcer was not very common and because of its long course of disease and mild symptoms, it was always misdiagnosed and perforation always ensued. There were many reason for the occurrence of non-infective cornea ulcers, the risk of cornea perforation depends upon the state of the illness.Attention should be paid upon the early identification of small perforation and tendency of perforation. When the area of the perforation was small, the aqueous liquid effused slowly, the anterior chamber become a little shallow or normal. Iris and lens were kept at their original places. Perforation will not happen at this time. Cornea can be dyed with fluorescence, the fluorescence at the site of perforation will be washed out slowly and cornea ulcer with perforation can be diagnosed then. Better prognosis will be gained after active therapy. In case that these kind of small perforation was neglected and the area increased, the treatment will be very hard and the prognosis very poor.Diagnosis of the cause of the disease will...
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