中国实用眼科杂志
中國實用眼科雜誌
중국실용안과잡지
CHINESE JOURNAL OF PRACTICAL OPHTHALMOLOGY
2014年
8期
941-945
,共5页
肖启国%李洁%费志刚%王智%夏世刚%周喆
肖啟國%李潔%費誌剛%王智%夏世剛%週喆
초계국%리길%비지강%왕지%하세강%주철
高危角膜移植%双板层角膜移植%穿透性角膜移植%效果
高危角膜移植%雙闆層角膜移植%穿透性角膜移植%效果
고위각막이식%쌍판층각막이식%천투성각막이식%효과
High-risk corneal transplantation%Double lamellar keratoplasty%Penetrating keratoplasty%Effect
目的 观察双板层角膜移植对高危角膜移植患者的治疗效果.方法 回顾性病例系列研究.选取2008年1月至2012年6月在南华大学附属第二医院接受手术的高危角膜移植患者25例(男性15例,女性10例),并按术式不同分为两组:双板层角膜移植组8例(男性5例,女性3例);穿透性角膜移植组17例(男性10例,女性7例).术后定期复查裸眼视力、眼压、眼底及裂隙灯检查;术后1、3、6、12个月行验光(查矫正视力)及角膜内皮细胞计数检查.采用秩和检验比较两组患者术前裸眼视力;采用Fisher确切概率法检验比较两组患者排斥反应发生率;采用t检验比较两组患者年龄、术后裸眼视力、矫正视力、眼压及角膜内皮细胞密度.结果 双板层角膜移植组患者平均年龄(43.6±16.5)岁,术前视力为FC/20 cm～0.1;穿透性角膜移植组患者平均年龄(45.3±15.7)岁,术前视力为FC/20 cm～0.08.两组患者年龄及术前视力比较差异无统计学意义(t=1.322,P=0.199;t=116.5,P =0.264).双板层角膜移植组裸眼视力在术后1、3、6、12个月均优于穿透性角膜移植组,差异比较有统计学意义(P＜0.05);矫正视力:术后1个月双板层角膜移植组较穿透性角膜移植组差异有统计学意义(t =2.637,P=0.014),术后3、6个月两组差异比较无统计学意义(t=1.544、1.592,P =0.137、0.135),术后1年双板层角膜移植组优于穿透性角膜移植组差异有统计学意义(t=2.216,P =0.038).两组患者角膜内皮细胞密度均呈明显下降趋势,但双板层角膜移植组角膜内皮细胞密度下降较穿透性角膜移植组缓慢.术后1、3、6、12个月双板层角膜移植组角膜内皮细胞密度均高于穿透性角膜移植组,两组差异比较有统计学意义(P＜0.05).穿透性角膜移植组有2例在手术后1个月内发生继发性青光眼,双板层角膜移植组均无病例发生.手术后1年内穿透性角膜移植组共有6例发生排斥反应,发生率为35.3％ (6/17);双板层角膜移植组有2例发生排斥反应,发生率为25％ (2/8),两组差异比较无统计学意义(P =0.487).经抗排斥处理,穿透性角膜移植组有4例排斥反应被控制,2例角膜植片出现混浊;双板层角膜移植组2例排斥反应均被控制,植片恢复透明.结论 对于高危角膜移植患者,双板层角膜移植较穿透性角膜移植视力恢复理想,内皮细胞密度下降缓慢,排斥反应发生率低,但仍需要大样本及长时间的观察来进一步证实.
目的 觀察雙闆層角膜移植對高危角膜移植患者的治療效果.方法 迴顧性病例繫列研究.選取2008年1月至2012年6月在南華大學附屬第二醫院接受手術的高危角膜移植患者25例(男性15例,女性10例),併按術式不同分為兩組:雙闆層角膜移植組8例(男性5例,女性3例);穿透性角膜移植組17例(男性10例,女性7例).術後定期複查裸眼視力、眼壓、眼底及裂隙燈檢查;術後1、3、6、12箇月行驗光(查矯正視力)及角膜內皮細胞計數檢查.採用秩和檢驗比較兩組患者術前裸眼視力;採用Fisher確切概率法檢驗比較兩組患者排斥反應髮生率;採用t檢驗比較兩組患者年齡、術後裸眼視力、矯正視力、眼壓及角膜內皮細胞密度.結果 雙闆層角膜移植組患者平均年齡(43.6±16.5)歲,術前視力為FC/20 cm～0.1;穿透性角膜移植組患者平均年齡(45.3±15.7)歲,術前視力為FC/20 cm～0.08.兩組患者年齡及術前視力比較差異無統計學意義(t=1.322,P=0.199;t=116.5,P =0.264).雙闆層角膜移植組裸眼視力在術後1、3、6、12箇月均優于穿透性角膜移植組,差異比較有統計學意義(P＜0.05);矯正視力:術後1箇月雙闆層角膜移植組較穿透性角膜移植組差異有統計學意義(t =2.637,P=0.014),術後3、6箇月兩組差異比較無統計學意義(t=1.544、1.592,P =0.137、0.135),術後1年雙闆層角膜移植組優于穿透性角膜移植組差異有統計學意義(t=2.216,P =0.038).兩組患者角膜內皮細胞密度均呈明顯下降趨勢,但雙闆層角膜移植組角膜內皮細胞密度下降較穿透性角膜移植組緩慢.術後1、3、6、12箇月雙闆層角膜移植組角膜內皮細胞密度均高于穿透性角膜移植組,兩組差異比較有統計學意義(P＜0.05).穿透性角膜移植組有2例在手術後1箇月內髮生繼髮性青光眼,雙闆層角膜移植組均無病例髮生.手術後1年內穿透性角膜移植組共有6例髮生排斥反應,髮生率為35.3％ (6/17);雙闆層角膜移植組有2例髮生排斥反應,髮生率為25％ (2/8),兩組差異比較無統計學意義(P =0.487).經抗排斥處理,穿透性角膜移植組有4例排斥反應被控製,2例角膜植片齣現混濁;雙闆層角膜移植組2例排斥反應均被控製,植片恢複透明.結論 對于高危角膜移植患者,雙闆層角膜移植較穿透性角膜移植視力恢複理想,內皮細胞密度下降緩慢,排斥反應髮生率低,但仍需要大樣本及長時間的觀察來進一步證實.
목적 관찰쌍판층각막이식대고위각막이식환자적치료효과.방법 회고성병례계렬연구.선취2008년1월지2012년6월재남화대학부속제이의원접수수술적고위각막이식환자25례(남성15례,녀성10례),병안술식불동분위량조:쌍판층각막이식조8례(남성5례,녀성3례);천투성각막이식조17례(남성10례,녀성7례).술후정기복사라안시력、안압、안저급렬극등검사;술후1、3、6、12개월행험광(사교정시력)급각막내피세포계수검사.채용질화검험비교량조환자술전라안시력;채용Fisher학절개솔법검험비교량조환자배척반응발생솔;채용t검험비교량조환자년령、술후라안시력、교정시력、안압급각막내피세포밀도.결과 쌍판층각막이식조환자평균년령(43.6±16.5)세,술전시력위FC/20 cm～0.1;천투성각막이식조환자평균년령(45.3±15.7)세,술전시력위FC/20 cm～0.08.량조환자년령급술전시력비교차이무통계학의의(t=1.322,P=0.199;t=116.5,P =0.264).쌍판층각막이식조라안시력재술후1、3、6、12개월균우우천투성각막이식조,차이비교유통계학의의(P＜0.05);교정시력:술후1개월쌍판층각막이식조교천투성각막이식조차이유통계학의의(t =2.637,P=0.014),술후3、6개월량조차이비교무통계학의의(t=1.544、1.592,P =0.137、0.135),술후1년쌍판층각막이식조우우천투성각막이식조차이유통계학의의(t=2.216,P =0.038).량조환자각막내피세포밀도균정명현하강추세,단쌍판층각막이식조각막내피세포밀도하강교천투성각막이식조완만.술후1、3、6、12개월쌍판층각막이식조각막내피세포밀도균고우천투성각막이식조,량조차이비교유통계학의의(P＜0.05).천투성각막이식조유2례재수술후1개월내발생계발성청광안,쌍판층각막이식조균무병례발생.수술후1년내천투성각막이식조공유6례발생배척반응,발생솔위35.3％ (6/17);쌍판층각막이식조유2례발생배척반응,발생솔위25％ (2/8),량조차이비교무통계학의의(P =0.487).경항배척처리,천투성각막이식조유4례배척반응피공제,2례각막식편출현혼탁;쌍판층각막이식조2례배척반응균피공제,식편회복투명.결론 대우고위각막이식환자,쌍판층각막이식교천투성각막이식시력회복이상,내피세포밀도하강완만,배척반응발생솔저,단잉수요대양본급장시간적관찰래진일보증실.
Objective To investigate the therapeutic effects of double lamellar keratoplasty (DLK) on patients with high-risk corneal transplantation.Methods A retrospective case series study.The study was made in 25 successional patients who had high-risk corneal transplantation in the Second Affiliated Hospital of Nanhua University from January 2008 to June 2012 (10 males and 7 females).Eight of whom accepted with DLK (5 males and 3 females),and 17 patients with penetrating keratoplasty (PKP) (10 males and 7 females).Visual acuity,best corrected visual acuity (BCVA),intraocular pressure,slit lamp examination,fundus examination and corneal endothelial cell density were checked in postoperative 1,3,6,and 12 months.Visual acuity preoperative between the two groups was compared using Kruskal-Wallis H test.The rate of rejection between the two groups was compared using Fisher's exact probability.Mean values for each experiment were compared between the two groups using LSD-t test.Results There were no significant difference (P ＞0.05) between DLK and PKP in the average age (43.6±6.5 v.s.45.3±15.7) and preoperative vision (FC/20cm～0.1 v.s.FC/20cm～0.08).The visual acuity of DLK group were better than PKP group in postoperative 1,3,6,and 12 months (P ＜0.05).The BCVA of DLK group were better than PKP group 12months after surgery (P ＜0.05).The corneal endothelial cell densities of two groups were decreased gradually.The corneal endothelial cell density of DLK group was higher than PKP group (P ＜0.05)during the review.There was no secondary glaucoma in DLK group,while 2 cases of PKP group appeared secondary glaucoma in a month after operation.In one year,there was no significant difference about the rate of rejection between the two groups (2 cases in DLK,25％ v.s.6 cases in PKP,35.3％).After anti-rejection treatment,2 patients of DLK group were controlled,and cornea graft restored to transparency.However,4 grafts in PKP group got back to clearly,the other 2 cases were still opacity.Conclusions DLK for corneal transplantation in high-risk eyes has a better BCVA,less endothelial cell lose,and probable lower incidence of rejection compared with PKR.
