飞秒激光辅助深板层角膜移植术联合他克莫司治疗感染性角膜炎的疗效  

Femtosecond laser-assisted deep anterior lamellar keratoplasty combined with tacrolimus in the treatment of infectious keratitis

作　　者：刘洋[1] 黄瑾[1] 王晶[1] 马君鑫 李中国[1] 王林农[1] LIU Yang;HUANG Jin;WANG Jing;MA Jun-xin;LI Zhong-guo;WANG Lin-nong(Department of Ophthalmology,Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital),Nanjing Jiangsu 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)眼科

出　　处：《局解手术学杂志》2019年第8期613-617,共5页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨飞秒激光辅助深板层角膜移植(DALK)术后联合他克莫司治疗感染性角膜炎的疗效。方法选择我院眼科2015年3月至2018年3月确诊的64例感染性角膜炎患者,按照手术方式分为2组,每组32例。2组患者在术前均给予抗感染药物规范治疗2周。观察组患者行飞秒激光辅助深板层角膜移植术,对照组患者行穿透性角膜移植术,术后2组患者均使用他克莫司滴眼液治疗。观察比较2组患者治疗有效率、最佳矫正视力、免疫排异反应、角膜表面曲率以及不良反应。结果观察组患者治疗有效率(90.63%)高于对照组(65.63%),差异有统计学意义(P=0.016)。通过对患者术后1个月、3个月、6个月的矫正视力对比观察,结果显示观察组患者均优于对照组;治疗后7 d、14 d观察组出现免疫排异反应的患者显著少于对照组;术后7 d、1个月、3个月观察组患者眼压明显低于对照组,以上差异均具有统计学意义(P<0.05)。术后6个月,2组患者眼压趋于稳定;治疗前后,2组患者的不同时点角膜表面曲率之间无显著差异。2组患者均未出现明显的不良反应。结论飞秒激光辅助DALK术联合他克莫司可显著改善感染性角膜炎患者术后视力和球内压力,治疗效果显著,安全性较高。Objective To observe the effect of femtosecond laser-assisted deep anterior lamellar keratoplasty(DALK)combined with tacrolimus in the treatment of infectious keratitis.Methods Sixty-four patients with infectious keratitis admitted into our hospital from March 2015 to March 2018 were selected as the research objects and divided into two groups according to the surgical approach,with 32 cases in each group.Patients of the two groups were given standard anti-infective drugs for 2 weeks after diagnosis.Patients of the observation group were treated with femtosecond laser-assisted DALK,while patients of the control group were treated with penetrating keratoplasty.And tacrolimus eye drops were used in both of the two groups after operation.The curative effect,best corrected visual acuity,immune rejection reaction,corneal surface curvature and adverse reactions were observed and compared between the two groups.Results The effective rate of the observation group(90.63%)was significantly higher than that of the control group(65.63%),with significant difference between the two groups(P=0.016).The corrected visual acuity of the patients in the observation group was better than that of the control group in 1 month,3 months and 6 months after operation.The immune rejection reaction of patients in the observation group was significantly lower than that of the control group in 7 days and 14 days after treatment;the intraocular pressure of patients in the observation group was significantly lower than that of the control group in 7 days,1 month and 3 months after operation.After 6 months,the intraocular pressure of the patients in the two groups tended to stabilize.There was no significant difference in corneal surface curvature between the two groups before and after treatment.There was no significant adverse reactions in both of the two groups.Conclusion Femtosecond laser-assisted DALK combined with tacrolimus significantly improves the postoperative visual acuity and intraocular pressure in patients with infectious keratitis

关 键 词：飞秒激光角膜板层刀移植术 他克莫司 免疫排异 眼压 感染性角膜炎 

分 类 号：R772.21[医药卫生—眼科]