穿透性角膜移植术与“双泡技术”深板层角膜移植术治疗晚期圆锥角膜疗效对比研究  

A comparative study on the efficacy of penetrating keratoplasty and double bubble deep lamellar keratoplasty in the treatment of advanced keratoconus

作　　者：陈颖欣 魏智媛 高明宏 CHEN Ying-xin;WEI Zhi-yuan;GAO Ming-hong(Department of Ophthalmology,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院眼科

出　　处：《临床军医杂志》2019年第11期1216-1219,共4页Clinical Journal of Medical Officers

摘　　要：目的比较穿透性角膜移植术(PKP)与"双泡技术"深板层角膜移植术(DALK)治疗包括急性水肿期在内的晚期圆锥角膜(KC)的临床疗效。方法选取自2007年10月至2018年1月于北部战区总医院接受角膜移植术治疗的47例(47眼)晚期KC患者为研究对象。根据治疗方法将患者分为DALK组(n=26)与PKP组(n=21)。术后随访1年以上,观察最佳矫正视力(BCVA)、角膜内皮细胞密度、术中术后并发症及植片生存率。结果术后1、6个月,PKP组的平均BCVA明显优于DALK组,差异有统计学意义(P<0.05);术后12个月,两组BCVA比较,差异无统计学意义(P>0.05)。术后6、12个月PKP组的平均内皮细胞密度低于DALK组,差异有统计学意义(P<0.05)。术中并发症:PKP组未发生术中并发症;DALK组3眼术中后弹力膜微穿孔。术后并发症:两组患者的高眼压、继发性青光眼、移植排斥反应发生率比较,差异有统计学意义(P<0.05)。两组患者随访至今均未发生原发性移植失败及角膜内皮失代偿,两组植片生存率均为100.0%,所有患者未见原病复发。结论 PKP与"双泡技术"DALK均为治疗晚期KC的安全、有效术式,二者术后增视效果类似。KC的急性水肿期并不是角膜移植手术禁忌症。Objective To compare the clinical efficacy of penetrating keratoplasty(PKP)and "double-bubble" deep lamellar keratoplasty(DALK)in the treatment of advanced keratoconus(KC),including acute edema.Methods A retrospective study was performed on 47 cases(47 eyes)of patients with advanced KC who were admitted and underwent keratoplasty from October 2007 to January 2018.Patients were divided into the DALK group(n=26)and PKP group(n=21)according to the treatment method.The best corrected visual acuity(BCVA),density of corneal endothelial cells,intraoperative and postoperative complications,and graft survival rate were observed after more than 1 year follow-up.Results One and six months after surgery,the mean BCVA of PKP group was significantly better than that of DALK group,with statistically significant difference(P<0.05).Twelve months after surgery,there was no significant difference in BCVA between the two groups(P>0.05).The average density of endothelial cells in PKP group was lower than that in DALK group six and twelve months after surgery(P<0.05).Intraoperative complications:no intraoperative complications occurred in PKP group.Microperforation of posterior elastic membrane in DALK group.Postoperative complications:the incidence of intraocular hypertension,secondary glaucoma and graft rejection between the two groups was statistically significant(P<0.05).No primary graft failure or corneal endothelium decompensation had occurred in the two groups since the follow-up,the survival rate of the graft in the two groups was 100.0%,and no recurrence of the original disease was observed in all the patients.Conclusion PKP and "double-bubble technique" DALK are both safe and effective surgical methods for the treatment of advanced KC,and their postoperative enhancement effects are similar.The acute edema stage of KC is not a contraindication to corneal transplantation.

关 键 词：圆锥角膜 穿透性角膜移植 深板层角膜移植 急性水肿 

分 类 号：R779.65[医药卫生—眼科]