光学性全厚板层角膜移植术治疗真菌性角膜炎的初步探讨  

Preliminary investigation of optical full thickness lamellar keratoplasty for fungal keratitis

作　　者：陈蔚[1] 张京娜 孙莉[1] 王世明 马慧香[1] 张晓博[1] 

机构地区：[1]温州医学院附属眼视光医院,浙江温州325027 [2]杭州市下沙医院眼科,浙江杭州310000 [3]福建泉州市妇女儿童医院眼科中心,福建泉州362000

出　　处：《眼视光学杂志》2009年第4期285-289,共5页Chinese Journal of Optometry & Ophthalmology

基　　金：温州市科技计划项目(Y2005A004)

摘　　要：目的初步探讨完全钝性分离的光学性全厚板层角膜移植术治疗真菌性角膜炎的可行性、安全性和增视效果。方法采用前瞻性非对照研究,对临床确诊为真菌性角膜炎且常规抗真菌药物治疗无效的患者行活体激光共焦显微镜检查,对其中明确菌丝未累及角膜深基质及后弹力层的21例患者(21眼)行完全钝性分离的光学性全厚板层角膜移植术。术后第1周、第1个月、第3个月、第6个月、第12个月和第18个月常规随访,观察角膜植片上皮愈合情况、有无真菌复发、免疫排斥反应、移植片透明度和最佳矫正视力等;术后第6个月和第12个月复查角膜内皮细胞密度。结果术前激光共焦显微镜检查,21只患眼均找到真菌菌丝,未见菌丝累及角膜深基质及后弹力层;术中无一例因后弹力层穿破而改行穿透性角膜移植术;仅1例在术后2周内出现真菌复发,复发率为4.76%。其余20例平均随访(14±6)个月,角膜植片均透明,治愈率为95.24%。术后第6个月,有14例术眼最佳矫正视力≥4.5,其中5例≥4.8。术后第6个月,平均角膜内皮细胞密度为(2296±368)个/mm2(1025～3491个/mm2);术后第12个月为(2337±357)个/mm2(1016～3380个/mm2)。结论光学性全厚板层角膜移植术是一种治疗真菌性角膜炎的有效手段,激光共焦显微镜有助于真菌的诊断和真菌浸润深度的判断,完全钝性分离的方法减少了前房穿孔率,提高了手术的成功率。Objective To investigate the efficacy and safety of optical full-thickness lamellar keratoplasty （OFLK） with eryopreserved donor corneas in the treatment of fungal keratitis. Methods OFLK was performed on 21 eyes of 21 patients with fungal keratitis that had not been cured by antifungal chemotherapy. Fungal hyphae and the infiltrating depth in all 21 corneas were confirmed by laser confocal microscopy before surgery. During the surgery, corneal stroma was removed and Descemet membrane was exposed by a completely blunt dissection with the use of a very fine forceps tip and a fine blunt spatula. Visual acuity, corneal clarity, and endothelium cell density were assessed at different time points after surgery. Results Fungal hyphae were imaged in all of the 21 patients and no filaments were found infiltrated in the deep stroma and Descemet membrane preoperatively. No intra-operative perforation of Descemet membrane occurred during surgery. Twenty cases resulted in the successful cure of fungal infection and were followed up for （14±6）months. Only one eye （4.76%） had a recurrence of the fungal infection within 2 weeks. The best-corrected visual acuity （BCVA）of 14 cases was above 4.5, 5 of which were above 4.8 at 6 months after surgery. Overall, mean endothelium cell density was （2337±357）cells/mm^2 （range 1016-3380 cells/mm^2） at 12 months after surgery. Conclusion OFLK is a safe and effective therapy for restoring visual acuity in the treatment of fungal keratitis. Laser confocal microscopy is helpful in the diagnosis of fungal keratitis and in judging the depth of the filament infiltration. Blunt separation decreases the percentage of intra-operative perforation of Descemet membrane.

关 键 词：共焦显微镜 真菌性角膜炎 板层角膜移植术 

分 类 号：R779.65[医药卫生—眼科]