CAJ | 학술논문

目的探讨部分板层角膜移植(LKP)术后早期角膜层间积液的发病特征,并观察层间放液法的治疗效果.方法回顾性系列病例研究.山东省眼科医院433例部分LKP患者中38例发生术后早期角膜层间积液,分析发生积液与不发生积液患者术前原发病、角膜供体材料的保存方法以及角膜植片与植床直径的差异.对发生层间积液的患者在显微镜下行角膜层间放液治疗,观察治疗效果.数据采用卡方检验进行分析.结果 38例(8.8％)部分LKP术后发生层间积液的患者中,圆锥角膜LKP术后发生层间积液的风险(15.9％)远远高于其他疾病.甘油冷冻保存供体层间积液发生率(10.4％)与DX液保存供体引起层间积液的发生率(4.3％)相比,差异有统计学意义(x2＝4.060,P＜0.05);甘油保存3年以上供体层间积液发生率(17.7％)与3年以内供体层间积液发生率(9.3％)差异有统计学意义(x2=12.152,P＜0.01).植片＞植床0.5 mm者(19.5％)较植片＞植床0.25 mm者(7.7％)更易发生积液(x2-6.521,P＜0.05).应用角膜层间放液法治疗后行裂隙灯检察,层间积液消失,植片植床相贴附,术后1周角膜植片均可恢复透明.1例圆锥角膜患者出现层间大量积液、瞳孔阻滞、继发性青光眼,急诊行虹膜周切术,解除瞳孔阻滞,病情得到控制.结论圆锥角膜行部分LKP术后层间积液的发生率高于其他疾病,甘油长期保存角膜供体、角膜植片对植床周边部的过度压迫是引起层间积液的重要因素;术后早期观察并及时采用层间放液法可以有效治疗角膜层间积液.
목적 탐토부분판층각막이식(LKP)술후조기각막층간적액적발병특정,병관찰층간방액법적치료효과.방법 회고성계렬병례연구.산동성안과의원433례부분LKP환자중38례발생술후조기각막층간적액,분석발생적액여불발생적액환자술전원발병、각막공체재료적보존방법이급각막식편여식상직경적차이.대발생층간적액적환자재현미경하행각막층간방액치료,관찰치료효과.수거채용잡방검험진행분석.결과 38례(8.8％)부분LKP술후발생층간적액적환자중,원추각막LKP술후발생층간적액적풍험(15.9％)원원고우기타질병.감유냉동보존공체층간적액발생솔(10.4％)여DX액보존공체인기층간적액적발생솔(4.3％)상비,차이유통계학의의(x2＝4.060,P＜0.05);감유보존3년이상공체층간적액발생솔(17.7％)여3년이내공체층간적액발생솔(9.3％)차이유통계학의의(x2=12.152,P＜0.01).식편＞식상0.5 mm자(19.5％)교식편＞식상0.25 mm자(7.7％)경역발생적액(x2-6.521,P＜0.05).응용각막층간방액법치료후행렬극등검찰,층간적액소실,식편식상상첩부,술후1주각막식편균가회복투명.1례원추각막환자출현층간대량적액、동공조체、계발성청광안,급진행홍막주절술,해제동공조체,병정득도공제.결론 원추각막행부분LKP술후층간적액적발생솔고우기타질병,감유장기보존각막공체、각막식편대식상주변부적과도압박시인기층간적액적중요인소;술후조기관찰병급시채용층간방액법가이유효치료각막층간적액.
Objective To investigate the clinical features of interface fluid at an early stage after partial lamellar keratoplasty (LKP) and observe the therapeutic effect of releasing interface fluid.Methods This was a retrospective,noncomparative clinical trial.Thirty-eight patients with onset of interface fluid were identified among 433 patients who underwent partial LKP at Shandong Eye Hospital from September 2007 to January 2011.Examinations were conducted 2 to 4 hours after surgery.The primary disease,the preservation of donor corneal tissue,and the size difference between the corneal graft and the recipient bed of the patients with interface fluid were assessed.The interface fluid was released immediately under a microscope,and the effect was evaluated.Data were analyzed using x2 test.Results Interface fluid was found in 38 cases (8.8％) at 2 to 4 hours after LKP,including 18 cases of keratoconus,which was significantly more than the other diseases.The rate of interface fluid in patients whose donor corneas were preserved in glycerin (10.4％) was higher than the rate in donor tissue preserved in a DX solution (4.3％,x2=4.060,P＜0.05).The rate of interface fluid in donor tissue preserved in glycerin more than 3 years (17.7％) was higher than that preserved for less than 3 years (9.3％,x2=12.152,P＜0.01).Corneal grafts 0.5 mm or larger than the recipient bed induced more interface fluid (19.5％) than those 0.25 mm or larger (7.7％,x2=6.521,P＜0.05).The graft and recipient bed attached tightly after the fluid was released,and regained transparency 1 week later.However,a large amount of interface fluid was found in 1 patient the day after LKP.The recipient tissue reflexed inward and attached to the anterior lens capsule.There was pupillary block combined with high intraocular pressure.Releasing the fluid alone could not restore the anterior chamber so peripheral iridectomy was performed.The intraocular pressure became normal after surgery,and the edema was absorbed by 1 week.Conclusion Interface fluid after partial LKP is closely related to keratoconus.Long-term glycerin preservation of corneal donors and excessive oppression of the graft to the recipient bed are also predisposing factors for interface fluid.It is important to check with slit lamp during the early stage after surgery.Immediate release of interface fluid is an effective method to avoid serious complications.