改良深板层角膜移植术治疗圆锥角膜患者术后屈光状态分析  

Analysis of refractive function after modified deep lamellar keratoplasty for keratoconus

作　　者：曲利军[1] 谢立信[2] 

机构地区：[1]哈尔滨医科大学附属第二医院眼科,黑龙江省哈尔滨市150086 [2]山东省眼科研究所,山东省眼科学重点实验室-省部共建国家重点实验室培育基地,山东省青岛市266071

出　　处：《眼科新进展》2010年第9期845-847,共3页Recent Advances in Ophthalmology

基　　金：青岛市科技发展计划项目重大专项基金(编号:02KGYSH-01)~~

摘　　要：目的探讨改良深板层角膜移植术(deep lamellar keratoplasty,DLKP)治疗圆锥角膜患者术后屈光状态的改变及相关因素的分析。方法回顾性分析改良DLKP治疗圆锥角膜患者45例(45眼)。记录患者术前和术后最后一次随访时(完全拆除缝线后6个月)的视力情况,术后1个月、6个月、12个月和18个月时的等效球镜(spherical equivalent,SE)、散光、角膜曲率和中央角膜厚度(central corneal thickness,CCT),观察术中、术后并发症。结果患者术前裸眼矫正视力均小于0.30,其中0.05以下者占26.7%;术后最后一次随访时患眼最佳矫正视力均在0.30以上,0.60以上者占24.4%。与术后1个月相比,术后12个月时SE增加了-2.25D(P=0.012),而散光减小了2.45D(P=0.015)。与术后1个月相比,术后6个月、12个月和18个月平均角膜曲率差异均无统计学意义(均为P>0.05)。术前平均角膜曲率(>60D或≤60D)对患者术后最后一次随访时的SE、散光和角膜曲率均无显著影响(P=0.110,P=0.322,P=0.466)。术后1a内CCT有变薄趋势;术后18个月时CCT为(571.9±27.8)μm,与术后12个月时CCT(577.0±31.7)μm相比,差异无统计学意义(P=0.623)。结论改良DLKP可以有效地改善圆锥角膜患者术后屈光状态,提高术后视力。Objective To evaluate the refractive function after modified deep lamellar keratoplasty（DLKP） for keratoconus,and analyze its related factors.Methods Forty-five patients（45 eyes） with keratoconus received the modified DLKP.The visual acuity before operation and at 6 months after completely removed the suture lines were recorded,the spherical equivalent（SE）,astigmatism,corneal curvature,central corneal thickness（CCT） at postoperative 1 month,6 months,12 months and 18 months were examined,and the in-operative and postoperative complications were also recorded.Results The preoperative uncorrected visual acuity of all patients was below 0.30,and 26.7% of the patients was below 0.05.The postoperative best corrected visual acuity of all patients at the last follow up were above 0.30,and 24.4% of the patients were above 0.60.The SE in postoperative 12 months increased -2.25 D than that in postoperative 1 month（P=0.012）.Astigmatism in postoperative 12 months decreased 2.45 D than that in postoperative 1 month（P=0.015）.The mean corneal curvatures at postoperative 6 months,12 months and 18 months did not change significantly compared with that at postoperative 1 month（P0.05）.Preoperative differences between two groups in mean corneal curvature（60 D or ≤60 D） had no significant effect on the postoperative SE,astigmatism and corneal curvature（P=0.110,P=0.322,P=0.466）.The thinning trend of CCT continued until postoperative 12 months,and then became stably.There was no statistical difference in CCT between postoperative 12 months（577.0±31.7） μm and postoperative 18 months（571.9±27.8） μm（P=0.623）.Conclusion The modified DLKP can improve the visual function of patient with keratoconus by the refractive reconstruction

关 键 词：圆锥角膜 深板层角膜移植术 屈光状态 

分 类 号：R777.2[医药卫生—眼科]