目的：研究板层角膜切除术联合那他霉素治疗真菌性角膜溃疡的临床疗效及组织病理学基础。 方法：选取2009-12/2011-11真菌性角膜溃疡患者32例32眼，角膜病变未累及内皮层，行角膜板层切除联合那他霉素滴眼治疗，观察记录治疗前后视力、角膜情况、病程、并发症及致病菌种类，对切除组织行组织病理学检查。 结果：治疗前视力≤0.05者20眼，~0.3者11眼，>0.3者1眼。板层切除术后联合那他霉素治疗痊愈28例（875%），治愈时间7~32（平均13.2±8.5）d，痊愈时视力≤0.05者5眼，~0.3者8眼，>0.3者15眼。病情控制不良改行角膜移植术者4例。31例真菌培养阳性（969%），其中镰刀菌18例，曲霉菌属8例，链格孢霉3例，未知菌属2例。病理学检查显示溃疡灶中有多量中性粒细胞浸润，过碘酸-希夫（PAS）染色显示角膜组织中菌丝多数位于角膜浅层，并呈与板层胶原纤维平行方向生长，但也有少数呈斜形或垂直生长方式，侵及切除组织全层。不同菌属之间菌丝在角膜中生长方式无明显差异。 结论：对于病变未累及全层的真菌性角膜溃疡患者，及时行板层角膜切除术可大大提高那他霉素药物治疗有效性，缩短病程，恢复视力。

AIM:To study the clinical outcome and pathological base of lamellar keratectomy combined with natamycin medication for the treatment of fungal corneal ulcer. METHODS:Thirty-two eyes of 32 cases suffered from fungal corneal ulcer in which the endothelium was not infected were included in this study. All patients received lamellar keratectomy combined with natamycin medication. Visual acuity, corneal infiltration, clinical outcome, complications and fungal species were recorded. Pathological examinations were conducted with the corneal lamellar tissues. RESULTS:Twenty cases had a preoperative visual acuity below 0.05，11 cases between 0.05 and 0.3，and 1 case between 0.3 and 1.0. Twenty-eight cases were healed by lamellar keratectomy combined with natamycin medication. The heal course ranged from 7 to 32 days, with an average time of 13.2±8.5 days. Postoperative evaluation showed that 5 cases had a visual acuity below 0.05，8 cases between 0.05 and 0.3，15 cases between 0.3 and 1.0. Four cases converted to keratoplasty due to uncontrolled infection. Positive cultures were found in 31 cases with 18 Fusarium species, 8 Aspergillus species, 3 Alternaria species and 2 uncertain species. Pathological examination showed dense infiltration of polymorphonuclears(PMNs), and periodic acid-schiff(PAS) staining demonstrated most hyphae lay in superior corneal lamellae and parallel to it, while little hyphae traversed the cornea in a plane perpendicular or inclined to the stromal lamellae. There was no significant difference in growth patterns in cornea between different pathogenic fungi. CONCLUSION: Timely lamellar keratectomy can significantly improve the efficiency of natamycin medication in fungal corneal ulcer and restore visual acuity.