【摘要】目的：探讨穿透性角膜移植术治疗外伤性角膜病变的临床疗效。方法：对17例外伤性角膜病变施行穿透性角膜移植术，2例行穿透性角膜移植术联合小梁切除术，观察术后角膜植片及视力变化。结果：随访6～18（平均11.2）mo，术后临床症状明显缓解或消失，植片透明率为84%。视力较术前提高，其中矫正视力0.05以上16例；术后继发性青光眼5例，内皮型排斥反应4例。结论：穿透性角膜移植术是治疗外伤性角膜病变的一种有效的手术方式，其主要并发症为继发性青光眼和角膜移植排斥反应。
【关键词】 穿透性角膜移植；外伤性角膜病变
Clinical observation of penetrating keratoplasty for treatment of traumatic keratopathy
GuoCang Chen, MeiZhu Chen, LiXia Yang, YingXiang Yu, YunPeng Wang
Department of Ophthalmology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou 350025, Fujian Province, China
Correspondence to: GuoCang Chen.
Department of Ophthalmology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou 350025, Fujian Province, China. [email protected]
Abstract AIM: To evaluate the effect of penetrating keratoplasty on treatment of traumatic keratopathy.METHODS: Seventeen cases of traumatic keratopathy were treated by penetraing keratoplasty, while 2 cases underwent penetrating keratoplasty combined with trabeculectomy. Corneal grafts and the changes in visual acuity were observed after operation.RESULTS: Corneal grafts and the changes in visual acuity were followed up for 6 to 18 months (11.2 months on average). All the clinical symptoms remitted or disappeared, the buttons were transparent and postoperative visual acuity was improved. Sixteen eyes had a corrected visual acuity of 0.05 or better and 4 eyes had 0.2 or better. Five cases of secondary glaucoma and 4 cases of endothelial rejection were found.CONCLUSION: The penetrating keratoplasty for treatment of traumatic keratopathy was effective. Postoperatively, the primary complications are glaucoma and graft rejection.
KEYWORDS: penetrating keratoplasty; traumatic kerat
opathy
引言
外伤性角膜病变是常见的的致盲原因之一，角膜移植是能够恢复这些患者的视力的唯一手段。本文回顾性分析穿透性角膜移植(penetrating keratoplasty, PPK)治疗外伤性角膜病变19例，对其临床特点和治疗进行总结，报告如下。
1对象和方法
1.1对象
19例患者中，男16例，女3例。患者年龄7～53（平均28.5）岁。临床检查：术前均行眼部B超检查，发现视网膜、脉络膜脱离者排除在本组病例外。（1）单纯外伤性角膜白斑3眼；（2）角膜白斑合并人工晶状体眼5眼；（3）角膜白斑合并无晶状体眼8眼；（4）多发性角膜深层异物2例；（5）大泡性角膜炎合并后房非金属异物1眼。外伤后角膜病变时间为1mo～2a。术前视力：19眼中光感或眼前手动者3眼，视力≤0.05者12眼，0.05以上4眼。
1.2方法
采用球后麻醉和局部浸润麻醉。行穿透性角膜移植17例，联合小梁切除术2例。角膜移植片取材于湿房保存的新鲜材料，手术在供眼采集后4～6h内进行。术前1h常规200g/L甘露醇250mL静滴，降低眼压手术须在手术显微镜下操作。以环钻于角膜中央处钻切病变角膜, 植床大小为7.25～7.50mm。植片较植孔大0.25～0.5mm。用100 尼龙线间断缝合16针或连续缝合, 用平衡盐溶液恢复前房。结膜下注射地塞米松、庆大霉素，绷带包扎双眼。联合小梁切除术手术方法按文献方法[1]进行。术后常规全身应用抗生素、激素3～5d，局部用抗生素、激素、角膜营养液点眼，术后起之3～4wk开始10g/L环孢霉素A眼液点眼，3次/d。门诊定期复查，及时发现并处理术后并发症。一般术后3～6mo拆角膜缝线。
2结果
2.1术后视力
术后术眼最佳矫正视力在0.05以下2眼，0.05以上16眼，其中0.2以上4例。
2.2术后角膜植片情况
随访6～18mo，4眼曾发生过角膜内皮型排斥反应，其中3眼排斥反应在1次以上。最短发生于术后1mo，最长发生于术后16（平均4.2）mo。发生排斥的眼中3眼经治疗后植片保持透明，1眼因角膜内皮失代偿导致混浊。随访时19眼，16眼植片保持透明，透明率为84%。
2.3其他并发症
术后继发青光眼5例，经药物降眼压治疗眼压仍不能控制3例，后行小梁切除手术，术后2例眼压维持在正常范围。1例小梁切除术后眼压仍不能控制者，行睫状体冷凝术后眼压控制在正常范围。
[1] [2] 下一页 |
