婴儿先天性角膜混浊行穿透性角膜移植术的临床疗效分析  

Clinical analysis of penetrating keratoplasty for infants with congenital corneal opacity

作　　者：苗森[1] 蔺琪[2] 孙亚杰 宋耀文 李旭 潘志强 Miao Sen;Lin Qi;Sun Yajie;Song Yaowen;Li Xu;Pan Zhiqiang(Department of Ophthalmology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Ophthalmology,Beijing Children′s Hospital,Capital Medical University,National Key Discipline of Pediatrics,Ministry of Education,Beijing 100045,China;Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Institute of Ophthalmology,Beijing Key Laboratory of Ophthalmology&Visual Sciences,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京安贞医院眼科,北京100029 [2]首都医科大学附属北京儿童医院眼科,儿科学国家重点实验室,北京100045 [3]首都医科大学附属北京同仁医院北京同仁眼科中心,北京市眼科研究所,北京市眼科学与视觉科学重点实验室,北京100730

出　　处：《中华眼科杂志》2022年第6期426-432,共7页Chinese Journal of Ophthalmology

摘　　要：目的探讨婴儿先天性角膜混浊(CCO)行穿透性角膜移植术(PK)后角膜植片的透明情况及其影响因素。方法回顾性队列研究。纳入2017年1月至2018年1月在首都医科大学附属北京同仁医院和首都医科大学附属北京安贞医院诊断为CCO并行PK的0~1岁患儿(42例,51只眼)资料。其中男性23例,女性19例;手术时年龄(5.7±2.2)个月;随访时间为(28.6±2.6)个月。记录患儿的基本信息、相关角膜疾病类型及角膜混浊形态。所有患儿均进行了PK术,术后定期随访角膜植片透明情况及出现的并发症,记录术后角膜植片存活情况。分类诊断、手术年龄以及联合手术等不同影响因素与植片生存之间采用Kaplan-Meier存活曲线及Log-rank检验分析,不同影响因素与透明角膜植片率之间的比较采用χ^(2)检验。结果术后6个月时透明角膜植片率为84.3%(43/51),12个月时下降至78.4%(40/51),至末次随访则进一步下降至60.8%(31/51)。A-R综合征及先天性小眼球术后透明角膜植片率(0)低于Peters异常(62.2%,23/37)和角膜巩膜化(8/11)(P<0.01),联合白内障摘除手术后透明角膜植片率(3/9)也低于单纯行PK者(66.7%,28/42)(P=0.039)。混浊角膜组织中有新生血管者术后透明角膜植片率低(43.5%,10/23),差异有统计学意义(χ^(2)=5.264,P=0.022)。术后常见的并发症为眼压升高(7只眼,13.7%)和持续性角膜上皮缺损(7只眼,13.7%),其次为并发性白内障(4只眼,7.8%)和后发性白内障(2只眼,3.9%)。结论1岁及以下的CCO患儿在行PK治疗后,随随访时间延长透明角膜植片率有下降趋势,但术后2年透明角膜植片率尚好。影响PK术后透明角膜植片率的因素主要包括角膜混浊组织中有新生血管、疾病类型及是否联合白内障摘除手术等。Objective To investigate the corneal graft survival and related risk factors of primary penetrating keratoplasty in congenital corneal opacity infants.Methods It was a retrospective cohort study.Data were collected from forty-two infants(51 eyes)who were aged≤12 months and diagnosed with congenital corneal opacity in Beijing Tongren Hospital and Beijing Anzhen Hospital from January 1,2017 to January 31,2018.The mean age at surgery was(5.7±2.2)months(3-12 months).The mean follow-up duration was(28.6±2.6)months(24-33 months).All the patients underwent penetrating keratoplasty.The status of the corneal grafts and complications were observed and recorded during the regular follow-up.The survival probabilities were estimated by using the Kaplan-Meier and Log-rank test.The graft survival between different influence factors was analyzed by using theχ^(2) test.Results The Kaplan-Meier survival rates for penetrating keratoplasty were 84.3%(43/51)at 6 months,78.4%(40/51)at 12 months and 60.8%(31/51)at the last follow-up.The presence of corneal neovascularization was significantly correlated with graft failure(χ^(2)=5.264,P=0.022).The graft survival differed between eyes receiving combined surgery and mere penetrating keratoplasty and in eyes with varied surgical indications(P=0.039,<0.01).Increased intraocular pressure(7 eyes,13.7%)and persistent epithelial defects(7 eyes,13.7%)were the most common postoperative complications,followed by complicated cataract(4 eyes,7.8%)and posterior capsule opacification(2 eyes,3.9%).Conclusions The graft survival rate was satisfactory following pediatric keratoplasty although it had a tendency to decrease with the follow-up time.Corneal neovascularization was a major risk factor of graft failure.Surgical indications and procedures also had a certain effect on the graft survival.

关 键 词：角膜混浊 角膜移植术 穿透性 移植物存活 治疗结果 婴儿 

分 类 号：R779.6[医药卫生—眼科]