中国实用眼科杂志
中國實用眼科雜誌
중국실용안과잡지
CHINESE JOURNAL OF PRACTICAL OPHTHALMOLOGY
2013年
3期
331-336
,共6页
薛晓燕%周善璧%张琪%胡柯%李鸿
薛曉燕%週善璧%張琪%鬍柯%李鴻
설효연%주선벽%장기%호가%리홍
穿透性%板层%角膜移植%再次%回顾性分析
穿透性%闆層%角膜移植%再次%迴顧性分析
천투성%판층%각막이식%재차%회고성분석
Penetrating%Lamellar%Keratoplasty%Repeat%Retrospective review
目的 对再次穿透性角膜移植(RPKP)及再次板层角膜移植(RLKP)的原发病因、直接病因、危险因素及疗效进行临床分析.方法 对2009年1月至2011年12月间在眼科住院治疗行再次角膜移植的21例(23只眼)患者进行回顾性分析,分析其原发疾病、再次手术直接原因、术中情况及手术效果.结果 行RPKP者11只眼(11例),原发疾病依次为感染性角膜炎5只眼(45.5％)、角膜白斑3只眼(27.3％)、角膜变性2只眼(18.2％)及化学烧伤1只眼(9.1％).RPKP直接病因依次为角膜排斥及其引起的混浊6只眼(54.5％)、植片溃疡穿孔2只眼(18.2％)、角膜慢性失功2只眼(CCAD)(18.2％)及原发病复发1只眼(9.1％).行RLKP者12只眼(10例),原发疾病依次为非感染性角膜炎5只眼(41.7％)、感染性角膜炎3只眼(25％)、角膜化学烧伤2只眼(16.7％)、角膜变性1只眼(8.3％)及热烧伤1只眼(8.3％).RLKP直接病因依次为角膜排斥及其引起的混浊8只眼(66.7％)、原发病复发3只眼(25％)及CCAD1只眼(8.3％).随访9～32月,平均(22.0±7.9)月,RPKP术后1只眼摘除眼球,RPKP和RLKP术后分别有63.6％及67.7％的患者视力得到提高,最佳视力分别为0.5及0.3,但分别有72.7％及66.7％的患者视力仍在数指以下.少部分患者在术后视力逐渐下降,随访时RPKP及RLKP视力下降者分别占27.2％及25％,分别有81.2％及75％的患者视力在数指以下.结论 RPKP原发疾病因以感染性角膜炎为主,而RLKP以非感染性角膜炎为主；RPKP与RLKP的首位直接病因都为角膜排斥及其引起的混浊,新生血管及植片过大可能是出现排斥反应的主要原因；RPKP与RLKP术后大部分患者视力提高,但多在数指以下,少部分在随访期间视力逐渐下降,提示再次角膜移植更大的意义可能在于保住眼球,以提高美观性、满足患者眼部和心理舒适度.
目的 對再次穿透性角膜移植(RPKP)及再次闆層角膜移植(RLKP)的原髮病因、直接病因、危險因素及療效進行臨床分析.方法 對2009年1月至2011年12月間在眼科住院治療行再次角膜移植的21例(23隻眼)患者進行迴顧性分析,分析其原髮疾病、再次手術直接原因、術中情況及手術效果.結果 行RPKP者11隻眼(11例),原髮疾病依次為感染性角膜炎5隻眼(45.5％)、角膜白斑3隻眼(27.3％)、角膜變性2隻眼(18.2％)及化學燒傷1隻眼(9.1％).RPKP直接病因依次為角膜排斥及其引起的混濁6隻眼(54.5％)、植片潰瘍穿孔2隻眼(18.2％)、角膜慢性失功2隻眼(CCAD)(18.2％)及原髮病複髮1隻眼(9.1％).行RLKP者12隻眼(10例),原髮疾病依次為非感染性角膜炎5隻眼(41.7％)、感染性角膜炎3隻眼(25％)、角膜化學燒傷2隻眼(16.7％)、角膜變性1隻眼(8.3％)及熱燒傷1隻眼(8.3％).RLKP直接病因依次為角膜排斥及其引起的混濁8隻眼(66.7％)、原髮病複髮3隻眼(25％)及CCAD1隻眼(8.3％).隨訪9～32月,平均(22.0±7.9)月,RPKP術後1隻眼摘除眼毬,RPKP和RLKP術後分彆有63.6％及67.7％的患者視力得到提高,最佳視力分彆為0.5及0.3,但分彆有72.7％及66.7％的患者視力仍在數指以下.少部分患者在術後視力逐漸下降,隨訪時RPKP及RLKP視力下降者分彆佔27.2％及25％,分彆有81.2％及75％的患者視力在數指以下.結論 RPKP原髮疾病因以感染性角膜炎為主,而RLKP以非感染性角膜炎為主；RPKP與RLKP的首位直接病因都為角膜排斥及其引起的混濁,新生血管及植片過大可能是齣現排斥反應的主要原因；RPKP與RLKP術後大部分患者視力提高,但多在數指以下,少部分在隨訪期間視力逐漸下降,提示再次角膜移植更大的意義可能在于保住眼毬,以提高美觀性、滿足患者眼部和心理舒適度.
목적 대재차천투성각막이식(RPKP)급재차판층각막이식(RLKP)적원발병인、직접병인、위험인소급료효진행림상분석.방법 대2009년1월지2011년12월간재안과주원치료행재차각막이식적21례(23지안)환자진행회고성분석,분석기원발질병、재차수술직접원인、술중정황급수술효과.결과 행RPKP자11지안(11례),원발질병의차위감염성각막염5지안(45.5％)、각막백반3지안(27.3％)、각막변성2지안(18.2％)급화학소상1지안(9.1％).RPKP직접병인의차위각막배척급기인기적혼탁6지안(54.5％)、식편궤양천공2지안(18.2％)、각막만성실공2지안(CCAD)(18.2％)급원발병복발1지안(9.1％).행RLKP자12지안(10례),원발질병의차위비감염성각막염5지안(41.7％)、감염성각막염3지안(25％)、각막화학소상2지안(16.7％)、각막변성1지안(8.3％)급열소상1지안(8.3％).RLKP직접병인의차위각막배척급기인기적혼탁8지안(66.7％)、원발병복발3지안(25％)급CCAD1지안(8.3％).수방9～32월,평균(22.0±7.9)월,RPKP술후1지안적제안구,RPKP화RLKP술후분별유63.6％급67.7％적환자시력득도제고,최가시력분별위0.5급0.3,단분별유72.7％급66.7％적환자시력잉재수지이하.소부분환자재술후시력축점하강,수방시RPKP급RLKP시력하강자분별점27.2％급25％,분별유81.2％급75％적환자시력재수지이하.결론 RPKP원발질병인이감염성각막염위주,이RLKP이비감염성각막염위주；RPKP여RLKP적수위직접병인도위각막배척급기인기적혼탁,신생혈관급식편과대가능시출현배척반응적주요원인；RPKP여RLKP술후대부분환자시력제고,단다재수지이하,소부분재수방기간시력축점하강,제시재차각막이식경대적의의가능재우보주안구,이제고미관성、만족환자안부화심리서괄도.
ObJective To investigate the major etiologies and outcomes of repeat penetrating keratoplasty (RPKP) and repeat lamellar keratoplasty (RLKP).Methods Retrospective review of 23 eyes from 21 patients underwent RPKP and RLKP from January 1,2009 through December 31,2011 in Department of Ophthalmology of the First Affiliated Hospital of Chongqing Medical University,to determine the major etiologies,time interval between 2 grafts,influencing factors and outcomes for RPKP and RLKP.Results Eleven eyes from 11 patients were involved in RPKP.Primary etiologies for RPKP were infectious keratitis (5 cases,45.5％),leucoma of cornea (3 cases,27.3％),corneal degeneration (2 cases,18.2％) as well as chemical burn (1 case,9.1％).The direct causes of RPKP were corneal rejection (6 cases,54.5％),perforation and ulcer of transplant (2 cases,18.2％),CCAD (2 cases,18.2％) and recurrence of primary disease (1 case,9.1％).Twelve eyes from 10 patients were involved in RLKP.Primary etiologies for RPKP were non-infectious keratitis (5 eyes,41.7％),infectious keratitis (3 eyes,25％),chemical burn (2 eyes,16.7％),corneal degeneration and dystrophy,as well as thermal burn (1 eye,8.3％).The direct causes of RLKP were corneal rejection (8 eyes,66.7％),recurrence of primary disease,leucoma of cornea (3 eyes,25％),and CCAD (1 eye,8.3％).All patients were followed form 9 to 32 months,with an average of (22.0±7.9) months.After RPKP,1 eye was enucleated.Visual acuity (VA) of 7 eyes (63.6％) was improved but gradually decreased in 3 eyes (27.2％).After RLKP,all 12 eyes were kept.VA of 8 eyes was improved,of which 3 eyes (25％) decreased gradually.Conclusions Infectious keratitis gave first place to the primary etiology of RPKP,while non-infectious keratitis is the first primary reason of RLKP.The direct etiology for both RPKP and RLKP is rejection of transplant,of which neovascularization and too large transplants may play an important role.After both of RPKP and RLKP,VA of most patients is improved but below finger counting.A part of patients presente a gradual decrease of VA after grafts.Therefore,repeat keratoplasty may be mainly for saving the eyeballs and improving the standard of living.
