CAJ | 학술논문

目的对穿透性角膜移植术后植片混浊的原因及二次穿透性角膜移植术的临床技巧及疗效进行初步研究.方法回顾性研究,对40例因植片混浊行二次穿透性角膜移植术的患者,对原发病、植片混浊原因和两次手术时间二次移植的植片的大小进行分析,随访观察植片透明度、视力及免疫排斥情况.结果感染性角膜炎居原发病首位.免疫排斥反应为植片混浊的主要原因,其次为植片感染性角膜炎复发、再发或继发.10例因植片感染于6个月及以内更换植片,30例因植片混浊于6个月以上更换植片.5例原直径过大而采用小直径植片;29例原直径≤8.25mm而采用等直径植片;6例因复发感染累及植片周边而扩大植片直径.随访32例植片(≤8.25mm)透明,视力较术前明显提高.8例植片混浊,其中5例混浊由免疫排斥所致.结论造成二次穿透性角膜移植术的主要原因为植片免疫排斥和感染性角膜炎复发、再发或继发,据植片混浊不同病因采取不同直径的二次植片可有效减低免疫排斥反应发生率及治疗原发病复发或再发,延长植片透明时间.
목적 대천투성각막이식술후식편혼탁적원인급이차천투성각막이식술적림상기교급료효진행초보연구.방법 회고성연구,대40례인식편혼탁행이차천투성각막이식술적환자,대원발병、식편혼탁원인화량차수술시간이차이식적식편적대소진행분석,수방관찰식편투명도、시력급면역배척정황.결과 감염성각막염거원발병수위.면역배척반응위식편혼탁적주요원인,기차위식편감염성각막염복발、재발혹계발.10례인식편감염우6개월급이내경환식편,30례인식편혼탁우6개월이상경환식편.5례원직경과대이채용소직경식편;29례원직경≤8.25mm이채용등직경식편;6례인복발감염루급식편주변이확대식편직경.수방32례식편(≤8.25mm)투명,시력교술전명현제고.8례식편혼탁,기중5례혼탁유면역배척소치.결론 조성이차천투성각막이식술적주요원인위식편면역배척화감염성각막염복발、재발혹계발,거식편혼탁불동병인채취불동직경적이차식편가유효감저면역배척반응발생솔급치료원발병복발혹재발,연장식편투명시간.
Objective To investigate the factors of allograft opacity after penetrating keratoplasty and evaluate the efficacy of repeat penetrating keratoplasty by individual clinical technique.Methods Forty cases suffered from allograft opacity after penetrating keratoplasty were treated by repeat penetrating keratoplasty.Primary disease and causes of allograft opacity were explored preoperatively.Donor allografts with the diameters of smaller than, equal to or larger than primary grafts according to causes of allograft opacity and the diameters of primary grafts were adopted during the operation.The transparency of corneal implants, visual acuity and immunological rejection were observed.Results Infectious keratitis was the dominant disease among protopathy.Immunological rejection was the major factor that caused allograft opacity, and the secondary factor was relapsed infectious keratitis of allograft.Ten opaque grafts caused by infectious kerefitis received ropcat PKP with or within 6 months; 30 opaque grafts followed immunological rejection received repeat PKP above 6 months.Five eyes with large primary grafts received smaller diamcter of allogafts.Twenty-nine opaque grafts smaller than 8.25mm received equal diameters of allografts.Six opaque gratis followed by relapsed infectious focus involved periphery recipient bed must be enlarged the plant bed.During the follow-up period, 32 allografts with the diamcter smaller than 8.25mm kept transparent, the visual acuities were better than that of before operation.Eight repeat allogafts woe opaque,in which 5 were caused by immunological rejection.Conclusions The main reason of repeat penetrating keratoplasty is allograft immunological rejection and recurred infectious keratitis.It can effectively reduce the incidence of immunological rejection, treat relapsed primary infection and prolong the survival time of repeat graft by adopting different diameters of repeat grafts according to different causes of allografts opacity.