双板层角膜移植对高危角膜移植患者疗效观察  

Investigation of the therapeutic effects on patients with high-risk corneal transplantation by double lamellar keratoplasty

作　　者：肖启国[1] 李洁[1] 费志刚[1] 王智[1] 夏世刚[1] 周喆[1] 

机构地区：[1]南华大学附属第二医院眼科,湖南衡阳421001

出　　处：《中国实用眼科杂志》2014年第8期941-945,共5页Chinese Journal of Practical Ophthalmology

基　　金：湖南省卫生厅科研基金（B2010-052）

摘　　要：目的 观察双板层角膜移植对高危角膜移植患者的治疗效果.方法 回顾性病例系列研究.选取2008年1月至2012年6月在南华大学附属第二医院接受手术的高危角膜移植患者25例（男性15例,女性10例）,并按术式不同分为两组：双板层角膜移植组8例（男性5例,女性3例）;穿透性角膜移植组17例（男性10例,女性7例）.术后定期复查裸眼视力、眼压、眼底及裂隙灯检查;术后1、3、6、12个月行验光（查矫正视力）及角膜内皮细胞计数检查.采用秩和检验比较两组患者术前裸眼视力;采用Fisher确切概率法检验比较两组患者排斥反应发生率;采用t检验比较两组患者年龄、术后裸眼视力、矫正视力、眼压及角膜内皮细胞密度.结果 双板层角膜移植组患者平均年龄（43.6±16.5）岁,术前视力为FC/20 cm～0.1;穿透性角膜移植组患者平均年龄（45.3±15.7）岁,术前视力为FC/20 cm～0.08.两组患者年龄及术前视力比较差异无统计学意义（t=1.322,P=0.199;t=116.5,P =0.264）.双板层角膜移植组裸眼视力在术后1、3、6、12个月均优于穿透性角膜移植组,差异比较有统计学意义（P＜0.05）;矫正视力：术后1个月双板层角膜移植组较穿透性角膜移植组差异有统计学意义（t =2.637,P=0.014）,术后3、6个月两组差异比较无统计学意义（t=1.544、1.592,P =0.137、0.135）,术后1年双板层角膜移植组优于穿透性角膜移植组差异有统计学意义（t=2.216,P =0.038）.两组患者角膜内皮细胞密度均呈明显下降趋势,但双板层角膜移植组角膜内皮细胞密度下降较穿透性角膜移植组缓慢.术后1、3、6、12个月双板层角膜移植组角膜内皮细胞密度均高于穿透性角膜移植组,两组差异比较有统计学意义（P＜0.05）.穿透性角膜移植组有2例在手术后1个月内发生继发性青光眼,双板层角膜移植组均无病例发生.手术后1年内穿透性角膜移植组共有6例发生�Objective To investigate the therapeutic effects of double lamellar keratoplasty （DLK） on patients with high-risk corneal transplantation.Methods A retrospective case series study.The study was made in 25 successional patients who had high-risk corneal transplantation in the Second Affiliated Hospital of Nanhua University from January 2008 to June 2012 （10 males and 7 females）.Eight of whom accepted with DLK （5 males and 3 females）,and 17 patients with penetrating keratoplasty （PKP） （10 males and 7 females）.Visual acuity,best corrected visual acuity （BCVA）,intraocular pressure,slit lamp examination,fundus examination and corneal endothelial cell density were checked in postoperative 1,3,6,and 12 months.Visual acuity preoperative between the two groups was compared using Kruskal-Wallis H test.The rate of rejection between the two groups was compared using Fisher＇s exact probability.Mean values for each experiment were compared between the two groups using LSD-t test.Results There were no significant difference （P 〉0.05） between DLK and PKP in the average age （43.6±6.5 v.s.45.3±15.7） and preoperative vision （FC/20cm～0.1 v.s.FC/20cm～0.08）.The visual acuity of DLK group were better than PKP group in postoperative 1,3,6,and 12 months （P 〈0.05）.The BCVA of DLK group were better than PKP group 12months after surgery （P 〈0.05）.The corneal endothelial cell densities of two groups were decreased gradually.The corneal endothelial cell density of DLK group was higher than PKP group （P 〈0.05）during the review.There was no secondary glaucoma in DLK group,while 2 cases of PKP group appeared secondary glaucoma in a month after operation.In one year,there was no significant difference about the rate of rejection between the two groups （2 cases in DLK,25% v.s.6 cases in PKP,35.3%）.After anti-rejection treatment,2 patients of DLK group were controlled,and cornea graft restored to transparency.However,4 grafts in PKP group got back to clearly,the other 2 cases were

关 键 词：高危角膜移植 双板层角膜移植 穿透性角膜移植 效果 

分 类 号：R779.65[医药卫生—眼科]