角膜移植治疗中重度眼化学伤并发症的疗效分析  

Clinical analysis of keratoplasty performed for complications of moderate or severe ocular chemical burns

作　　者：王金梅[1] 周鸿雁[1] 谷树严[1] 

机构地区：[1]吉林大学中日联谊医院眼科,长春130031

出　　处：《中国实用眼科杂志》2007年第11期1180-1183,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的对比评价不同术式角膜移植治疗中、重度眼化学烧伤并发症和后遗症的疗效。方法收集我院1993年2月至2005年2月手术治疗的中、重度化学眼烧伤27例34眼,分别行全角膜板层移植术11眼,带巩膜环全角膜板层移植术4眼及部分穿透性角膜移植术19眼。随访6～24个月。术后观察角膜植片愈合情况、排斥反应的发生、角膜植片透明度、新生血管、视力及术后并发症,并对出现情况给予相应处理。结果术后视力提高者25眼（73.5%）,视力不变者9眼（26.5%）。9眼植片透明,24眼半透明,1眼混浊。术后并发症有排斥反应15眼（44.1%）,继发性青光眼3眼（8.8%）,角膜新生血管34眼（100%）,假性胬肉复发12眼（35.3%）,感染1眼,层间积血3眼。结论角膜移植术是治疗中、重度眼化学烧伤并发症的有效方法。针对不同眼部病变选用不同术式可提高手术成功率。术前或术中眼部基本条件的改善对角膜移植术的成功至关重要。带巩膜环全角膜板层移植术对于伴有假性胬肉,且不伴有角膜穿孔的中、重度眼化学烧伤并发症是一种有效的治疗方法,优于全角膜板层移植术。部分穿透性角膜移植术对于单纯性角膜白斑、角膜穿孔者疗效较好。Purpose To evaluate the clinical effects on three kinds of keratoplasties,as the treatments of complications of moderate or severe ocular chemical burns.Method 34 eyes of 27 patients（from Feb.1993 to Feb.2005）suffered from moderate or severe ocular chemical burns were studied.They were treated with total lamellar keratoplasty（11 eyes）,total lamellar cornea with circle lamellar sclera transplantation（CST,4 eyes）and penetrating keratoplasty（PKP 19 eyes）respectively.We observed and analyzed the postoperative status of corneal grafts,neovascularizations,rejections and visual acuities,during 6-24 months followed-up（12.3 months in average）.Result All corneal grafts survived and ocular surface reconstructions were successful and remained stable except one eye was infected after operation.Visions in 25 eyes（73.5%）were improved in different degrees and there were no changes in 9 eyes（26.5%）.In 9 eyes,corneal grafts were transparent,24 eyes semitransparent and 1 eye opacity.Rejection was happened in 15 eyes（44.1%）,secondary glaucomas in 3 eyes（8.8%）,neovascularizations in all eyes and infection in 1 eye.Conclusions Keratoplasty is an effective method to restore the integrity of corneal surface for eyes with moderate or severe ocular chemical burns.Using various keratoplasties on eyes with different state of illness will increase the successful rate of keratoplasty.The improvement of these eye conditions plays an important role in corneal transplantation.CST is a better method for eyes with pterygium and without corneal perforation than total lamellar keratoplasty while PKP is the best method for eyes with corneal perforation in the three kinds of keratoplasties.

关 键 词：眼化学烧伤 全角模板层移植术 带巩膜环全角膜板层移植术 部分穿透性角膜移植术 

分 类 号：R473.77[医药卫生—护理学]