中华眼外伤职业眼病杂志
中華眼外傷職業眼病雜誌
중화안외상직업안병잡지
CHINESE JOURNAL OF OCULAR TRAUMA AND OCCUPATIONAL EYE DISEASE
2014年
1期
27-30
,共4页
陈铁红%李绍伟%郭作锋%吕芳齐
陳鐵紅%李紹偉%郭作鋒%呂芳齊
진철홍%리소위%곽작봉%려방제
角膜炎,病毒性%角膜移植术,深板层%视力
角膜炎,病毒性%角膜移植術,深闆層%視力
각막염,병독성%각막이식술,심판층%시력
Keratitis,viral%Keratoplasty,deep lamellar%Visual acuity
目的 分析深板层角膜移植术治疗瘢痕期病毒性角膜炎的临床效果.方法 临床诊断明确的瘢痕期病毒性角膜炎48例(48只眼).均有不同程度及大小的角膜白斑和基质层的新生血管,部分患眼伴有角膜基质水肿,视力均低于0.1.术前给予积极的局部和全身糖皮质激素和抗病毒治疗,然后行深板层角膜移植术,术后随访2～48个月,观察视力、植片透明度、复发率及术中术后并发症.结果 3只眼术中发生后弹力层破裂,其中2只眼行前房注气术后植片与植床贴服良好,1只眼术中改为穿透性角膜移植术,其余45只眼均接受深板层角膜移植术,手术均顺利,1只眼术后1个月更换角膜植片,3只眼复发未及时随访治疗导致植片浑浊血管化,经治疗恢复透明,4只眼出现上皮型免疫排斥反应,经积极治疗后植片恢复透明.所有术眼视力均有不同程度的提高,最佳矫正视力≥0.25者13只眼,0.12 ～0.2者15只眼,≤0.1者20只眼.结论 深板层角膜移植术可以比较有效地治疗瘢痕期病毒性角膜炎,后弹力层的瘢痕和皱褶是影响术后视力恢复的主要原因,因此对于瘢痕期病毒性角膜炎应早行手术治疗.
目的 分析深闆層角膜移植術治療瘢痕期病毒性角膜炎的臨床效果.方法 臨床診斷明確的瘢痕期病毒性角膜炎48例(48隻眼).均有不同程度及大小的角膜白斑和基質層的新生血管,部分患眼伴有角膜基質水腫,視力均低于0.1.術前給予積極的跼部和全身糖皮質激素和抗病毒治療,然後行深闆層角膜移植術,術後隨訪2～48箇月,觀察視力、植片透明度、複髮率及術中術後併髮癥.結果 3隻眼術中髮生後彈力層破裂,其中2隻眼行前房註氣術後植片與植床貼服良好,1隻眼術中改為穿透性角膜移植術,其餘45隻眼均接受深闆層角膜移植術,手術均順利,1隻眼術後1箇月更換角膜植片,3隻眼複髮未及時隨訪治療導緻植片渾濁血管化,經治療恢複透明,4隻眼齣現上皮型免疫排斥反應,經積極治療後植片恢複透明.所有術眼視力均有不同程度的提高,最佳矯正視力≥0.25者13隻眼,0.12 ～0.2者15隻眼,≤0.1者20隻眼.結論 深闆層角膜移植術可以比較有效地治療瘢痕期病毒性角膜炎,後彈力層的瘢痕和皺褶是影響術後視力恢複的主要原因,因此對于瘢痕期病毒性角膜炎應早行手術治療.
목적 분석심판층각막이식술치료반흔기병독성각막염적림상효과.방법 림상진단명학적반흔기병독성각막염48례(48지안).균유불동정도급대소적각막백반화기질층적신생혈관,부분환안반유각막기질수종,시력균저우0.1.술전급여적겁적국부화전신당피질격소화항병독치료,연후행심판층각막이식술,술후수방2～48개월,관찰시력、식편투명도、복발솔급술중술후병발증.결과 3지안술중발생후탄력층파렬,기중2지안행전방주기술후식편여식상첩복량호,1지안술중개위천투성각막이식술,기여45지안균접수심판층각막이식술,수술균순리,1지안술후1개월경환각막식편,3지안복발미급시수방치료도치식편혼탁혈관화,경치료회복투명,4지안출현상피형면역배척반응,경적겁치료후식편회복투명.소유술안시력균유불동정도적제고,최가교정시력≥0.25자13지안,0.12 ～0.2자15지안,≤0.1자20지안.결론 심판층각막이식술가이비교유효지치료반흔기병독성각막염,후탄력층적반흔화추습시영향술후시력회복적주요원인,인차대우반흔기병독성각막염응조행수술치료.
Objective To evaluate the clinical efficacy of the deep lamellar keratoplasty (DLKP) in the treatment of viral keratitis in scaring period.Methods DLKP was performed on 48 eyes of 48 cases of viral keratitis in scaring period which was complicated with corneal scarring,edema and vascularized stroma.All the eyes had visual acuity ＜ 0.1 and were treated by local and systemic antiviral therapy before surgery,and then the DLKP were performed.A follow-up arranging from 2 to 48 months was conducted to investigate the visual acuity,condition of graft,surgical complications and the postoperative recurrent rate.Results 45 cases were successfully treated by standard DLKP.Three cases were complicated with tear of Descemet' s membrane.In which two cases were treated by gas injection in anterior chamber.And the graft attached to the bed successfully.And one case was treated by penetrating keratoplasty.The postoperative complications were stated as follows.One case received a changed graft,3 cases occurred with viral recurrence,and 4 cases occurred with epithelial rejection.All grafts turned transparent after further treatment.The best corrected visual acuity achieved 0.25 or better in 13 cases,0.12 to 0.2 in 15 cases and no better than 0.1 in 20 cases.Conclusion DLKP is an effective treatment for viral keratitis.The wrinkles and scar in the Descemet' s membrane is the mean cause of reduced visual acuity after surgery.An early operation for viral keratitis in scaring period is recommended.
