【摘要】 目的：评价用保存角膜行植床带周边后板层的大植片穿透性角膜移植术（PKP）的临床疗效和并发症。方法：回顾性分析200312/200612我院收治的角膜严重病变的患者108例（116眼），其中用保存角膜联合植床带周边后板层大植片穿透性角膜移植治疗63眼为改良组，用传统手术方式新鲜角膜植片移植治疗53眼。比较两组术后的角膜植片、排斥反应及并发症情况。结果：改良手术组治疗的63眼中，8眼（12.7%）发生不同程度的植片排斥反应、术后浅前房2眼(3.2%)、虹膜前粘连1眼(1.6%)、继发青光眼2眼(3.2%)；传统手术组治疗的53眼中，植片排斥反应15眼（28.3%）、术后浅前房11眼(20.8%)、虹膜前粘连8眼(15.1%)、继发青光眼6眼(11.3%)。两组的术后的植片排斥反应率和并发症有显著差异（P<0.05）。结论：用保存角膜联合植床带周边后板层行大植片穿透性角膜移植术是降低术后免疫排斥反应，延长植片的存活时间的有效方法。
【关键词】 大植片；角膜移植术；穿透性；保存角膜；新鲜角膜
Clinical study of posterior lamellar largegraft penetrating keratoplasty using storage cornea
XuLi Zhao, ZhuLin Hu, Yan Li
Department of Ophthalmology, the Fourth Affiliated Hospital of Kunming Medical College, Kunming 650021, Yunnan Province, China
Correspondence to: ZhuLin Hu.Department of Ophthalmology, the Fourth Affiliated Hospital of Kunming Medical College, Kunming 650021, Yunnan Province, China. [email protected]
AbstractAIM: To evaluate the clinical effects and complications of largegraft penetrating keratoplasty (PKP) using storage cornea by applying peripheral posterior lamella in the recipients bed.METHODS: A total of 108 cases (116 eyes) with severe keratopathy admitted into our hospitalbetween December 2003 and December 2006 were retrospectively analyzed. 63 eyes in modified group were treated with posterior lamellar largegraft PKP using storage cornea, while 53 eyes were treated with traditional PKP using fresh cornea.The incidence of graft immune rejection and complications were compared between two groups after the operation.RESULTS: Among 63 eyes treated by storage cornea in modified group, 8 eyes (12.7%) had immune rejection; 2 eyes (3.2%) had shallow anterior chamber; 1 eye (1.6%) had anterior synechia; 2 eyes (3.2%) had secondary glaucoma. Among 53 eyes treated by fresh cornea in traditional group, 15 eyes (28.3%) hadimmune rejections; 11 eyes (20.8%) had shallow anterior chamber; 8 eyes (15.1%) had anterior synechia; 6 eyes (11.3%) hadsecondary glaucoma. There were statistically significant differences between two groups in the aspect of immune rejection and complications after the operation (P＜0.05).CONCLUSION: PKP using storage cornea with peripheral posterior lamella in the recipients bed is an effective way to reduce the incidence of graft immune rejections and prolong the corneal survival time.
KEYWORDS: large graft; keratoplasty; penetrating; storage cornea; fresh cornea
引言
目前，角膜移植是角膜疾病致盲的唯一复明手段，移植术后的排斥反应是影响手术成功的主要因素。我院于200312/200612用保存角膜联合植床带周边后板层行大植片穿透性角膜移植63眼，用传统的大植片新鲜角膜移植53眼，临床疗效比较如下。
1对象和方法
1.1对象
两组病例均为严重角膜病变并且须行大植片穿透移植治疗的患者共108例（116眼）。其中男61例（65眼），女47例（51眼），年龄9～79（平均47.5±9.1）岁。病因分类：改良组63眼中：真菌性角膜炎23眼，细菌性角膜炎10眼，病毒性角膜炎7眼，化学伤或热烧伤12眼，大泡性角膜炎6眼，角膜白斑5眼。传统组53眼中：真菌性角膜炎18眼，细菌性角膜炎11眼，病毒性角膜炎5眼，化学伤或热烧伤9眼，大泡性角膜炎7眼，角膜白斑3眼。以上所有病例角膜的病变范围均超过8mm，感染性角膜炎伴溃疡者均有不同程度的前房积脓，其中25眼有角膜新生血管。
1.2方法
供体角膜：保存角膜为20℃甘油保存的全层角膜1wk左右；新鲜角膜为死亡后1h内采集的眼球无菌处理后4℃湿房保存，6h内施行手术。改良组的手术方法：(1) 植床制作：用合适的环钻钻至2/3角膜厚度，再用15°刀做角膜板层水平向心性剥切至3/4角膜厚度，形成板层植床，然后用小于板层孔2mm的环钻，行深层角膜环切至4/5角膜厚度后，用15°刀在8∶30～7∶00处穿入前房，注入高粘型玻璃酸钠(viscot)和透明质酸钠(爱维)，角膜剪沿环切口剪除病变角膜。清理病灶、前房内渗出物和脓苔，及残余角膜板层，保留植床周边后板层1～2mm，同一植床不同部位的后板层宽度可不等，根据后板层上病灶浸润情况来修整，有些病例周边后板层可部分缺损，以尽量清除病灶为原则。（2）植片制作：用大于植床板层孔0.25～0.75mm的环钻钻取供体角膜植片；（3）以100尼龙线四针定位后间断缝合植片，达水密状态，平衡盐水建前房；（4）球结膜下注射庆大霉素2万U及地塞米松2.5mg（若怀疑真菌感染，则改用2g/L大扶康0.5mL）。 术后用抗生素、激素眼液及环孢霉素A眼液滴眼,角膜缝线一般在1～1.5a内拆除。传统组用新鲜角膜行传统的穿透性角膜移植术。植片出现水肿混浊，增厚，伴有或不伴有新生血管浸润均视为植片排斥反应。术后1a内每1～2mo随访1次，其后每3～12mo随访1次。平均随访时间为6～40(24.6±9.4)mo。
统计学处理：应用SPSS13.0统计软件对两组术后的植片排斥反应和并发症进行χ2检验。
[1] [2] [3] 下一页 |
