深板层及穿透性角膜移植术治疗圆锥角膜术后屈光状态的比较  

Comparison of refractive status after deep lamellar and penetrating keratoplasty for keratoconus

作　　者：韩莎莎[1] 王婷[2] 孟丽丽[3] 史伟云[3] 

机构地区：[1]青岛大学医学院,山东省青岛市266071 [2]山东省眼科医院,山东省青岛市266071 [3]山东省眼科研究所,山东省青岛市266071

出　　处：《眼科新进展》2013年第9期836-838,850,共4页Recent Advances in Ophthalmology

基　　金：国家自然科学基金资助(编号:81271036)~~

摘　　要：目的比较圆锥角膜患者行深板层角膜移植术(deep lamellar keratoplasty,DALK)与穿透性角膜移植术(penetrating keratoplasty,PKP)后的屈光状态,从而探讨DALK的有效性及安全性。方法回顾性分析2006年1月至2010年12月在青岛眼科医院行角膜移植的圆锥角膜患者85例(90眼),其中行DALK者45例(48眼),行PKP者40例(42眼),记录观察术前及术后1个月、6个月、12个月、24个月、36个月的最佳矫正视力(best corrected visual acuity,BCVA)情况,术后1个月、6个月、12个月、24个月、36个月的等效球镜(spherical equivalent,SE)、散光,术后1个月、6个月、12个月、24个月、36个月、48个月的最大角膜曲率,并观察两组术后并发症。结果两组术前BCVA均未超过0.3。术后1个月、6个月、36个月,PKP组BCVA明显好于DALK组,差异均有统计学意义(均为P<0.05);术后12个月、24个月两组差异均无统计学意义(均为P>0.05)。两组术后6个月、12个月SE差异均有统计学意义(均为P<0.05)。两组术后散光差异均无统计学意义(均为P>0.05)。DALK组术后6个月、12个月、24个月、36个月最大角膜曲率与术后1个月相比差异均无统计学意义(均为P>0.05);PKP组术后最大角膜曲率有逐渐增大趋势,术后6个月、12个月最大角膜曲率与术后1个月相比差异均无统计学意义(均为P>0.05),而术后24个月、36个月、48个月较术后1个月均明显增加(均为P<0.05)。DALK组术后6眼发生植片哆开,5眼术后3个月内发生后弹力层皱褶;PKP组术后9眼发生排斥反应,1眼移植失败,5眼发生植片哆开,2眼发生继发性青光眼。结论 DALK治疗圆锥角膜术后视力良好,并发症少,且不需要新鲜角膜供体,是一种临床效果较好的手术方式。Objective To explore the validity and safety of deep lamellar kerato- plasty（DALK） by comparing refractive status after DALK and penetrating keratoplasty （PKP） for keratoconus. Methods Retrospective analyses of clinical records of 85 pa- tients（90 eyes） who had received keratoplasty in our hospital from January,2006 to De- cember,2010 were conducted. Of all the patients, 45 cases （ 48 eyes ） had received DALK,40 cases（42 eyes） had received PKP. Preoperative best corrected visual acuity （BCVA） was observed and recorded; BCVA, spherical equivalent （ SE ） and astigmatism at 5 postoperative points-in-time （ 1 month, 6 months, 12 months, 24 months and 32 months after the operation） were observed and recorded; mean maximum corneal cur- vature at postoperative 6 points-in-time （ 1 month, 6 months, 12 months, 24 months, 32 months and 48 months after the operation） were observed and recorded. Postoperative complications were also monitored. Results Preoperative BCVA of both groups were not higher than 0.3. At the lst,2nd and 5th points-in-time ,BCVA of PKP group were sig- nificantly better than those of DALK group（All P 〈 0.05 ） ;At the 3rd and 4th points-in- time, BCVA of the 2 groups were not significantly different from each other （ Both P 〉 0. 05 ）. At the 2nd and 3rd points-in-time, SE of the 2 groups were significantly different from each other （ Both P 〈 0.05 ）. Postoperative astigmatism of the 2 groups at all 5 points-in-time were not significantly different from each other（All P 〉 0.05 ）. Compared with that at the 1 st point-in-time, mean maximum corneal curvature of DALK group at the 2nd,3rd,4th and 5th points-in-time were not significantly different（ All P 〉0.05 ）. Postoperative mean maximum corneal curvature of PKP group trended to increase grad- ually：compared with that at the 1 st point-in-time, mean maximum corneal curvature of PKP group at the 2nd and 3rd points-in-time were not significantly higher （ Both P 〉 0.05 ） ;Mean maximum co

关 键 词：圆锥角膜 深板层角膜移植术 穿透性角膜移植术 屈光状态 

分 类 号：R779.65[医药卫生—眼科]