CAJ | 학술논문

目的观察分析大直径穿透性角膜移植(LDPK)治疗严重真菌性角膜炎(FK)术后复发和免疫排斥反应发生的特点和规律,为提高手术后植片的长期存活提供参考.方法回顾性病例研究.对2009年1月至2013年12月在青岛眼科医院行LDPK(植片直径大于9 mm)治疗严重FK的70例(70眼)患者进行随访,随访时间为6～48个月,观察感染的菌种类型及其分布情况、术后真菌复发和植片免疫排斥反应的特点和规律.对裸眼视力(UCVA)、最佳矫正视力(BCVA)和植片存活情况等进行随访.结果 70例患者发病至接受LDPK术的间隔时间为(23.7±11.7)d.真菌培养示首位菌种为镰刀菌属(72％).LDPK术后,8例(11％)患者真菌复发,平均复发时间为(6.8±2.9)d.65例(93％)患者保存了眼球.26例(37％)患者术后1个月内发生内皮型免疫排斥,平均排斥发生时间为(17.8±5.1)d,21例经抗排斥治疗后植片恢复透明;5例遗留局部或全角膜植片混浊.至最后一次随访,39例(56％)患者角膜植片透明,植片内皮细胞密度平均为(1 306±816)个/mm2,UCVA平均为4.0±3.8,BCVA平均为4.5±4.1.结论 LDPK术后真菌复发和免疫排斥反应的时间差存在规律,这个时间窗对在术后2周应用糖皮质激素预防免疫排斥反应和防止复发有积极意义.
목적 관찰분석대직경천투성각막이식(LDPK)치료엄중진균성각막염(FK)술후복발화면역배척반응발생적특점화규률,위제고수술후식편적장기존활제공삼고.방법 회고성병례연구.대2009년1월지2013년12월재청도안과의원행LDPK(식편직경대우9 mm)치료엄중FK적70례(70안)환자진행수방,수방시간위6～48개월,관찰감염적균충류형급기분포정황、술후진균복발화식편면역배척반응적특점화규률.대라안시력(UCVA)、최가교정시력(BCVA)화식편존활정황등진행수방.결과 70례환자발병지접수LDPK술적간격시간위(23.7±11.7)d.진균배양시수위균충위렴도균속(72％).LDPK술후,8례(11％)환자진균복발,평균복발시간위(6.8±2.9)d.65례(93％)환자보존료안구.26례(37％)환자술후1개월내발생내피형면역배척,평균배척발생시간위(17.8±5.1)d,21례경항배척치료후식편회복투명;5례유류국부혹전각막식편혼탁.지최후일차수방,39례(56％)환자각막식편투명,식편내피세포밀도평균위(1 306±816)개/mm2,UCVA평균위4.0±3.8,BCVA평균위4.5±4.1.결론 LDPK술후진균복발화면역배척반응적시간차존재규률,저개시간창대재술후2주응용당피질격소예방면역배척반응화방지복발유적겁의의.
Objective To observe the characteristics and regularity of recurrent and immune rejection after large-diameter penetrating keratoplasty (LDPK) for the treatment of severe fungal keratitis;to provide a reference for improving the postoperative long-term survival of corneal grafts.Methods In a retrospective case series study, 70 patients (70 eyes) with severe fungal keratitis who underwent LDPK (≥9.0 mm) at Qingdao Eye Hospital between January 2009 and December 2013 were included.The follow-up after surgery ranged from 6 to 48 months.The fungal strains were identified, the characteristics and frequency of recurrent and immune rejection episodes were monitored and the long-term survival of corneal grafts was evaluated.Uncorrected visual acuity and best corrected visual acuity were recorded.Results The average time of onset for all patients was 23.7±11.7 days.Fungal cultures showed that the main fungus was fusarium (72％).Postoperatively, 8 patients (11％) underwent recurrent fungal infection and the average recurrence time was 6.8±2.9 days.Sixty-five patients (93％) successfully maintained the structural integrity of the globe.The immunologic rejection occurred within one month after the surgery in 26 patients (37％) and the average rejection time was 17.8±5.1 days.Of these, 21 cases were treated in time, and the grafts became transparent after routine anti-rejection therapy, while the remaining grafts became partially or entirely opaque.Thirty-nine patients (56％) had a clear corneal graft at the last follow-up.Average endothelial cell density was 1 306±816/mm2, average UCVA was 4.0±3.8, and average BCVA was 4.5±4.1.Conclusion LDPK is an effective surgical method in the management of severe keratitis with a high success rate in restoring anatomical integrity and providing useful vision.Postoperatively, there is a regularity in the duration of time between fungal recurrence and immune rejection, which indicates the use of glucocorticoids within 2 weeks after surgery to prevent recurrent and immnune rejection episodes.