中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2014年
5期
415-419
,共5页
角膜/内皮%角膜移植%角膜后弹力层%角膜后弹力层剥除联合自动角膜刀取材内皮移植术%视力
角膜/內皮%角膜移植%角膜後彈力層%角膜後彈力層剝除聯閤自動角膜刀取材內皮移植術%視力
각막/내피%각막이식%각막후탄력층%각막후탄력층박제연합자동각막도취재내피이식술%시력
Cornea/endothelium%Corneal transplantation%Descemet membrane%Descemet stripping automated endothelial keratoplasty%Visual acuity
背景 角膜后弹力层剥除联合自动角膜刀取材内皮移植术(DSAEK)是目前治疗角膜内皮失代偿的首选术式,但不同角膜病变患者术后视力恢复情况国内外的报道有所不同. 目的 比较不同病因所致角膜内皮失代偿患者DSAEK术后视功能的恢复情况,评价不同角膜病变对DSAEK术后视力的影响. 方法 回顾性分析2007年12月至2009年12月在北京大学第三医院眼科就诊的角膜内皮失代偿患者67例71眼的临床资料,根据原发病因的不同将其分为Fuchs角膜内皮营养不良组19例22眼、白内障术后大泡性角膜病变组36例37眼及其他因素引起的角膜内皮失代偿者(其他病因组)12例12眼,所有患眼均行DSAEK,分析其术后第1、3、7、30、90、180天各组术眼视力改善情况,采用SPSS 16.0统计学软件的x2检验和重复测量两因素方差分析对各组术眼手术前后不同视力的眼数分布及不同病因组在不同时间点LogMAR视力的差异进行比较. 结果 入选的71眼中,71.83％的患眼术前视力低于0.1,所有患眼视力均低于0.3.术前Fuchs角膜内皮营养不良组、白内障术后大泡性角膜病变组和其他病因组总体比较视力差异无统计学意义(x2=3.427,P＞0.05).术后第1 80天,Fuchs角膜内皮营养不良组视力≥0.8者5眼,占22.73％,略高于白内障术后大泡性角膜病变组的10.81％和其他病因组的8.33％,但3个组间不同视力的眼数分布差异无统计学意义(x2=0.330,P＞0.05).3个组患眼随着术后时间的延长,LogMAR视力值逐渐下降,差异有统计学意义(F时间=88.000,P＜0.01);术后第7天,白内障术后大泡性角膜病变组LogMAR视力值为1.29±0.57,明显高于Fuchs角膜内皮营养不良组的0.82±0.43和其他病因组的0.91±0.39,差异均有统计学意义(P＜0.05);术后第90天,Fuchs角膜内皮营养不良组LogMAR视力值为0.40±0.28,明显低于白内障术后大泡性角膜病变组的0.64±0.44和其他病因组的0.73±0.54,差异均有统计学意义(P＜0.05);而术后第180天,3个组间LogMAR视力值的差异均无统计学意义(P＞0.05).Fuchs角膜内皮营养不良组视力在术后3个月时达稳定,白内障术后大泡性角膜病变组和其他病因组术后90～ 180 d视力仍有变化. 结论 DSAEK是治疗各种角膜内皮失代偿的有效方法,Fuchs角膜内皮营养不良、白内障术后大泡性角膜病变和其他病因引起的角膜病变行DSAEK术后6个月视力均恢复较好,但Fuchs角膜内皮营养不良患者术后视力恢复更快.
揹景 角膜後彈力層剝除聯閤自動角膜刀取材內皮移植術(DSAEK)是目前治療角膜內皮失代償的首選術式,但不同角膜病變患者術後視力恢複情況國內外的報道有所不同. 目的 比較不同病因所緻角膜內皮失代償患者DSAEK術後視功能的恢複情況,評價不同角膜病變對DSAEK術後視力的影響. 方法 迴顧性分析2007年12月至2009年12月在北京大學第三醫院眼科就診的角膜內皮失代償患者67例71眼的臨床資料,根據原髮病因的不同將其分為Fuchs角膜內皮營養不良組19例22眼、白內障術後大泡性角膜病變組36例37眼及其他因素引起的角膜內皮失代償者(其他病因組)12例12眼,所有患眼均行DSAEK,分析其術後第1、3、7、30、90、180天各組術眼視力改善情況,採用SPSS 16.0統計學軟件的x2檢驗和重複測量兩因素方差分析對各組術眼手術前後不同視力的眼數分佈及不同病因組在不同時間點LogMAR視力的差異進行比較. 結果 入選的71眼中,71.83％的患眼術前視力低于0.1,所有患眼視力均低于0.3.術前Fuchs角膜內皮營養不良組、白內障術後大泡性角膜病變組和其他病因組總體比較視力差異無統計學意義(x2=3.427,P＞0.05).術後第1 80天,Fuchs角膜內皮營養不良組視力≥0.8者5眼,佔22.73％,略高于白內障術後大泡性角膜病變組的10.81％和其他病因組的8.33％,但3箇組間不同視力的眼數分佈差異無統計學意義(x2=0.330,P＞0.05).3箇組患眼隨著術後時間的延長,LogMAR視力值逐漸下降,差異有統計學意義(F時間=88.000,P＜0.01);術後第7天,白內障術後大泡性角膜病變組LogMAR視力值為1.29±0.57,明顯高于Fuchs角膜內皮營養不良組的0.82±0.43和其他病因組的0.91±0.39,差異均有統計學意義(P＜0.05);術後第90天,Fuchs角膜內皮營養不良組LogMAR視力值為0.40±0.28,明顯低于白內障術後大泡性角膜病變組的0.64±0.44和其他病因組的0.73±0.54,差異均有統計學意義(P＜0.05);而術後第180天,3箇組間LogMAR視力值的差異均無統計學意義(P＞0.05).Fuchs角膜內皮營養不良組視力在術後3箇月時達穩定,白內障術後大泡性角膜病變組和其他病因組術後90～ 180 d視力仍有變化. 結論 DSAEK是治療各種角膜內皮失代償的有效方法,Fuchs角膜內皮營養不良、白內障術後大泡性角膜病變和其他病因引起的角膜病變行DSAEK術後6箇月視力均恢複較好,但Fuchs角膜內皮營養不良患者術後視力恢複更快.
배경 각막후탄력층박제연합자동각막도취재내피이식술(DSAEK)시목전치료각막내피실대상적수선술식,단불동각막병변환자술후시력회복정황국내외적보도유소불동. 목적 비교불동병인소치각막내피실대상환자DSAEK술후시공능적회복정황,평개불동각막병변대DSAEK술후시력적영향. 방법 회고성분석2007년12월지2009년12월재북경대학제삼의원안과취진적각막내피실대상환자67례71안적림상자료,근거원발병인적불동장기분위Fuchs각막내피영양불량조19례22안、백내장술후대포성각막병변조36례37안급기타인소인기적각막내피실대상자(기타병인조)12례12안,소유환안균행DSAEK,분석기술후제1、3、7、30、90、180천각조술안시력개선정황,채용SPSS 16.0통계학연건적x2검험화중복측량량인소방차분석대각조술안수술전후불동시력적안수분포급불동병인조재불동시간점LogMAR시력적차이진행비교. 결과 입선적71안중,71.83％적환안술전시력저우0.1,소유환안시력균저우0.3.술전Fuchs각막내피영양불량조、백내장술후대포성각막병변조화기타병인조총체비교시력차이무통계학의의(x2=3.427,P＞0.05).술후제1 80천,Fuchs각막내피영양불량조시력≥0.8자5안,점22.73％,략고우백내장술후대포성각막병변조적10.81％화기타병인조적8.33％,단3개조간불동시력적안수분포차이무통계학의의(x2=0.330,P＞0.05).3개조환안수착술후시간적연장,LogMAR시력치축점하강,차이유통계학의의(F시간=88.000,P＜0.01);술후제7천,백내장술후대포성각막병변조LogMAR시력치위1.29±0.57,명현고우Fuchs각막내피영양불량조적0.82±0.43화기타병인조적0.91±0.39,차이균유통계학의의(P＜0.05);술후제90천,Fuchs각막내피영양불량조LogMAR시력치위0.40±0.28,명현저우백내장술후대포성각막병변조적0.64±0.44화기타병인조적0.73±0.54,차이균유통계학의의(P＜0.05);이술후제180천,3개조간LogMAR시력치적차이균무통계학의의(P＞0.05).Fuchs각막내피영양불량조시력재술후3개월시체은정,백내장술후대포성각막병변조화기타병인조술후90～ 180 d시력잉유변화. 결론 DSAEK시치료각충각막내피실대상적유효방법,Fuchs각막내피영양불량、백내장술후대포성각막병변화기타병인인기적각막병변행DSAEK술후6개월시력균회복교호,단Fuchs각막내피영양불량환자술후시력회복경쾌.
Background Descemet stripping automated endothelial keratoplasty (DSAEK) is the main treatment for corneal endothelial dysfunction.But the visual outcome after operation varies depending on the difference of corneal diseases.Objective This study was to evaluate and compare the visual outcomes following DSAEK in different keratopathy.Methods The clinical data of 72 eyes of 67 patients with endothelial dysfunction underwent DSAEK from December 2007 to December 2009 at Peking University Third Hospital were retrospectively analyzed.The patients were divided into Fuchs endothelial dystrophy (FED) group (22 eyes of 19 cases),cataract surgeryinduced bullous keratopathy group (37 eyes of 36 eases) and other endothelial keratopathy group (12 eyes of 12 cases).The distribution of visual acuity and LogMAR acuities were compared and evaluation among the 3 groups before operation and 1 day,3,7,30,90 and 180 days after operation.Results Preoperatively,the vision was lower than 0.1 in 71.83％ patients,and all the patients had the visual acuity less than 0.3.No significant difference was found in the preoperative acuity among the FED group,cataract surgery-induced bullous keratopathy group and other endothelial keratopathy group(x2 =3.427,P＞0.05).The visual acuity was ≥ 0.4 in 40 eyes (56.34％) and ≥ 0.1 in 65 eyes (91.55％),and the percentage of vision ≥0.8 was 22.73％ in the FED group,10.81％ in the cataract surgery-induced bullous keratopathy group and 8.33％ in the other endothelial keratopathy group,and no significant difference was found in the percentage of eyes in different visual acuities 180 days after operation (x2 =0.330,P＞ 0.05).In the 3 groups,LogMAR values were gradually decreased with the lapse of the time,showing a significant difference (Ftime =88.000,P ＜ 0.01).In the seventh day after operation,LogMAR value was 1.29 ± 0.57 in the cataract surgery-induced bullous keratopathy group,which was significantly higher than that of the FED group (0.82± 0.43) or other endothelial keratopathy group (0.91 ±0.39) (both at P＜0.05).Ninety days after operation,LogMAR value was 0.40 ±0.28 in the FED group and was significantly declined in comparison with the cataract surgeryinduced bullous keratopathy group (0.64±0.44) and other endothelial keratopathy group (0.73±0.54) (both at P＜0.05).However,no significant differences was seen in the LogMAR values among the three groups 180 days after operation (all at P＞0.05).The vision was stable 3 months after operation in the FED group,however,the vision was still changed over 3 months in the cataract surgery-induced bullous keratopathy group and other endothelial keratopathy group.Conclusions DSAEK is available for corneal endothelial diseases.Visual acuity improves more rapid in FED patients than other keratopathies.
