桥状瓣穿透性角膜移植术和带角巩膜缘的全板层角膜移植术治疗球形角膜5例的临床分析  

Surgical treatment of keratoglobus:key techniques of bridge-shaped flap penetrating keratoplasty and whole lamellar keratoplasty with corneoscleral limbal

作　　者：程钧 翟华蕾 王君怡 董燕玲 王爽 丛林 谢立信 Cheng Jun;Zhai Hualei;Wang Junyi;Dong Yanling;Wang Shuang;Cong Lin;Xie Lixin(Qingdao Eye Hospital,State Key Laboratory Cultivation Base,Shandong Provincial Key Laboratory of Ophthalmology,Shandong Eye Institute,Shandong First Medical University Shandong Academy of Medical Sciences,Qingdao 266071,China)

机构地区：[1]山东第一医科大学(山东省医学科学院)山东省眼科研究所,山东省眼科学重点实验室-省部共建国家重点实验室培育基地,青岛眼科医院,266071

出　　处：《中华眼科杂志》2019年第12期916-922,共7页Chinese Journal of Ophthalmology

基　　金：山东省自然科学基金(ZR2017BH026)。

摘　　要：目的探讨桥状瓣穿透性角膜移植术和带角巩膜缘全板层角膜移植术对球形角膜的治疗效果。方法回顾性病例研究。收集2010年1月至2015年12月于青岛眼科医院进行手术治疗的5例(8只眼)球形角膜患者的资料,其中男性4例,女性1例年龄3~67岁。记录患者的病史、诊断、视力、屈光状态、中央角膜厚度、手术方式及术后情况,随访1.0~4.5年。结果3只眼行桥状瓣穿透性角膜移植术(2只眼因外伤导致角膜穿通伤,1只眼后弹力层脱离),5只眼行带角巩膜缘全板层角膜移植术治疗。5例患者中,3例较年幼的患者同时合并蓝巩膜。术前患者视力均低于0.05,行带角巩膜缘全板层角膜移植术的患者术后平均视力为0.2,行桥状瓣穿透角膜移植术的患者术后平均视力为0.5,行桥状瓣穿透性角膜移植术的3只眼术后角膜上皮均在1周内完全愈合,且未再次出现角膜上皮缺损。行全板层角膜移植术的1只眼术后角膜上皮持续缺损,行睑裂缝合术治疗后上皮愈合;另一只眼术后角膜上皮愈合缓慢,戴角膜绷带镜2个月后角膜上皮完全愈合;其余3只眼角膜上皮均在1周内完全愈合。行桥状瓣穿透性角膜移植术的患眼中有2只眼在术后2个月时发生角膜植片免疫排斥,给予抗排斥治疗后角膜植片恢复透明;行全板层角膜移植术的患者无角膜植片免疫排斥发生。结论对角膜持续变薄,矫正视力不能提高的球形角膜患者行含角巩膜缘的全板层角膜移植术可有效加固角膜,避免轻微外伤导致的角膜贯通伤,提高患者视力。对于已发生无法修复的角膜贯通伤或后弹力层脱离的患者行桥状瓣穿透性角膜移植术亦可获得良好的视力预后.Objective Introduce the surgical techniques of bridge-shaped flap penetrating keratoplasty and whole lamellar keratoplasty with corneoscleral limbal and the comparison of therapeutic effects on keratoglobus.Methods Five patients(eight eyes)with keratoglobus from January 2010 to December 2015 were included.Three eyes received bridge-shaped flap penetrating keratoplasty(two eyes with corneal penetrating injury due to trauma,one eye with descemet′s membrane detachment)and five eyes received whole lamellar keratoplasty with corneoscleral limbal.Results The patients(four male,one female)aged 3 to 67 years old.Three younger patients were complicated with blue sclera.The visual acuity of all the patients pre-operation were lower than 0.05.The average visual acuity after whole lamellar keratoplasty(LKP)surgery was 0.2,while the average visual acuity after bridge-shaped flap penetrating keratoplasty(PKP)was 0.5.The corneal epithelium of the three eyes received bridge-shaped flap PKP surgery was completely healed within a week with no recurrence of corneal epithelial defect.Whereas one eye after whole LKP surgery arised persistent corneal epithelial defect and healed after blepharorrhaphy.The corneal epithelial of another eye after whole LKP surgery healed slowly and was completely healed after wearing a bandage lens on corneal for 2 months.The corneal epithelial of the remaining three eyes after whole LKP surgery was completely healed within a week.Two eyes received bridge-shaped flap PKP surgery arised corneal graft rejection 2 months after operation and recovered after anti-rejection treatment.No corneal graft rejection arised in the patients receiving whole LKP surgery.Conclusions The whole lamellar keratoplasty with corneoscleral limbal could effectively reinforce corneal,avoid corneal penetrating injury caused by minor trauma,and improve visual acuity in keratoglobus whose corneas were gradually thinning and corrected vision cannot be improved.The patients with corneal perforating injury or descemet′s membrane de

关 键 词：角膜移植术 穿透性 角膜移植 眼损伤 穿透性 预后 

分 类 号：R47[医药卫生—护理学]