甘油保存角膜行深板层角膜移植治疗真菌性角膜溃疡的临床观察  

Clinical observation of deep lamellar keratoplasty by Glycerine preserved corneas for treating fungal keratitis

作　　者：陈金鹏[1] 徐辉勇[1] 章剑[1] 张鹏[1] 陈蔚[2] 

机构地区：[1]武汉大学医学院附属鄂州市中心医院,湖北鄂州436000 [2]温州医科大学附属眼视光医院,浙江325027

出　　处：《中国实用眼科杂志》2014年第5期630-633,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的评价应用无水甘油冷冻保存角膜植片行深板层角膜移植术治疗真菌性角膜炎的临床疗效。方法对2006年7月至2010年11月在温州医科大学附属眼视光医院就诊的37例患者（37只眼）临床确诊为真菌性角膜炎，术前行激光共聚焦显微镜检查明确菌丝未累及角膜后弹力层，应用无水甘油保存角膜行深板层角膜移植术，术后随访6～24个月，观察术后视力、角膜植片透明度变化、角膜地形图、角膜内皮细胞密度、感染复发情况并分析。结果术中有4例（10．8％）出现微小穿孔，未因穿孔而改行穿透性角膜移植术；1例在术后2周内出现真菌复发，改行穿透性角膜移植术。手术拆线后2周最佳矫正视力22只眼高于0．5，占61．1％（22／36），29只眼高于0．3，占80．6％（29／36）。术后1、3个月及拆线后2周角膜地形图散光呈现递减的趋势，分别为（4．3±2．2）D、（3．4±2．0）D和（2．1±1．2）D；视力和角膜地形图不同时间点比较，差异均有统计学意义（P〈0．05）。术后1、3个月及12个月角膜植片内皮细胞密度分别为（2396±1219）、（2364±1164）、（2323±1173）个／mm^2。术后2例出现植片水肿混浊，经抗排斥治疗后均恢复透明。结论采用无水甘油冷冻保存的角膜植片行深板层角膜移植术，治疗未累及后弹力层的真菌性角膜溃疡，是一种安全、有效地手术方式。Objective To evaluate the efficacy and safety of deep lamellar keratoplasty （DLK） by anhydrous glycerine freezing-preserved corneas for treating fungal keratitis. Methods Thirty-sev-en （37 eyes） were diagnosed as fungal keratitis, and were not involved Descemet membrane by la-ser confocal microscopy before surgery. DLK was performed with anhydrous glycerine freezing-pre-served cornea. The effectiveness of operation was clinically observed and evaluated, include visual acuity, corneal transparency, topography and endothelium cell density. Results During surgery, four eyes had mini-rupture of the DM and were finished by reserving few deep stroma. Only one eye had a recurrence of the fimgal infection within 2 weeks and operated by penetrating keratoplasty （PKP）. The best-corrected visual acuity （BCVA） of 22 cases was above 0.5, 29 of which were above 0.3 at two weeks after suture removal. The corneal topography astigmatism appeared a decreas-ing trend, was （4.3±2.2）D, （3.4±2.0）D and （2.1±1.2）D at 1 month, 3 months after surgery and 2 weeks after suture removal. There were significant differences （P 〈0.01） in BCVA and corneal topog-raphy astigmatism at different time. Mean endothelium cell density was （2396±1219） cells /mm^2,（2364±1164） cells /mm^2 and （2323±1173） cells /mm^2 at 1 month, 3 and 12 months after surgery. Two eyes appeared graft edema and became transparent after anti-rejection therapy. Conclusions DLK with anhydrous glycerine freezing-preser±ed cornea is a safe and effective therapy in the treat-ment of fungal keratitis not involving Descemet.

关 键 词：甘油冷冻保存 真菌性角膜炎 深板层角膜移植 

分 类 号：R779.12[医药卫生—眼科]