穿透性角膜移植治疗LASIK术后继发圆锥角膜  

Penetrating keratoplasty for secondary keratoconus after Laser in situ keratomileusis

作　　者：姚晓明[1] 黎明[1] 于莉[1] 齐卫[1] 诸凤娇[1] 袁凤波[1] 姚迪[2] 

机构地区：[1]暨南大学附属深圳眼科中心,深圳市眼科医院,广东518040 [2]悉尼大学医学院

出　　处：《中国实用眼科杂志》2010年第10期1115-1117,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的 观察穿透性角膜移植治疗准分子激光原位角膜磨削术（Laserin situkeratomileusis,LASIK）术后继发圆锥角膜的效果.方法 对6例LASIK术后确诊为继发圆锥角膜的患者进行穿透性角膜移植术,选用直径7～7.5mm植片,与植床等大.术后随访1～5年,观察和评价其疗效.结果 本研究6例患者LASIK术前角膜厚度平均为394.9μm.术后圆锥发生时间（13±3.4）个月,穿透性角膜移植术后,中央角膜厚度平均为504.7μm,视力明显增进,随访期内未见圆锥角膜复发.讨论我们建议,进行LASIK对术中切削时,角膜基质床的厚度不应小于270μm,角膜总厚度不应小于400μm.对LASIK术后继发圆锥角膜患者行穿透性角膜移植术,植床直径与角膜植片等大,术后再选择性拆除缝线,将有助于降低术后免疫排斥反应发生率和圆锥复发,减少手术源性散光,提高视力.Objective To investigate the therapeutic effect of penetrating keratoplasty （PKP） for secondary keratoconus after Laser in situ keratomileusis （LASIK）. Methods Six eyes of secondary keratoconus after LASIK undergoing PKP were analyzed with 7.5mm transplant which had the same diameter that positively matching the recipient bed. The therapeutic effect had been monitored and assessed for the follow-up 1 to 5 years. Results Post-operatively, the six patients had an average 504.7＋8.3μ m of central cornea thickness.The visual acuity improved obviously and there was no recurrence of keratoconus during the follow-up period.Conclusions It is encouraged that during the PKP, the thickness of stromal bed should be less than 270μ m,and the overall thickness of cornea after photoablation should be greater than 400μ m. For the ectatic corneas followed by LASIK, it is essential to replace the abnormal cornea by a same diameter donor button, and the sutures will be removed under the guidance of corneal topography. A lower occurrence of immunological rejection, iatrogenic astigmatism and good vision would be expected to occur.

关 键 词：准分子激光原位角膜磨削术 圆锥角膜 角膜移植 穿透性 

分 类 号：R779.65[医药卫生—眼科]