發(fā)布時(shí)間：2018-07-20 21:25

【摘要】：目的：總結(jié)我院自2009年1月至2012年1月期間患大泡性角膜病變并行角膜內(nèi)皮移植術(shù)且有術(shù)后定期隨訪患者的臨床病例，對(duì)患者的年齡、發(fā)病原因、術(shù)前患眼情況及伴隨癥狀等與術(shù)后恢復(fù)情況的關(guān)系進(jìn)行分析，探討角膜內(nèi)皮移植術(shù)治療大泡性角膜病變的臨床效果、不良反應(yīng)的預(yù)防及處理。 方法：對(duì)患大泡性角膜病變并行角膜內(nèi)皮移植術(shù)的17例(17只眼)進(jìn)行回顧性研究�？偨Y(jié)角膜內(nèi)皮移植術(shù)治療大泡性角膜病變的臨床效果，術(shù)后臨床癥狀的改善及視力恢復(fù)情況，術(shù)前術(shù)后角膜中央厚度及透明性的對(duì)比，術(shù)后內(nèi)皮細(xì)胞計(jì)數(shù)的下降以及并發(fā)癥情況。 結(jié)果：大泡性角膜病變最常見病因?yàn)榘變?nèi)障摘除、人工晶狀體植入術(shù)后，共9例（其中有1例合并陳舊性眼爆炸傷），占總數(shù)52.9%；17例患者術(shù)后當(dāng)日疼痛、角膜刺激癥狀消失，術(shù)后當(dāng)日或術(shù)后第一日角膜大泡消失，至術(shù)后一周角膜光滑、透明，厚度接近正常，本組17例患者術(shù)后一周角膜中央厚度平均為（578±30）μm，較術(shù)前明顯降低；17例患者中除1例視網(wǎng)膜挫傷，術(shù)后視力無提高外，，其余16例視力均有不同程度提高，術(shù)后1周最佳矯正視力最高達(dá)0.3，至術(shù)后1個(gè)月最佳矯正視力最高達(dá)0.6，術(shù)后1個(gè)月平均散光為（1.72±0.87）D；術(shù)后植片內(nèi)皮細(xì)胞計(jì)數(shù)均有不同程度下降，至術(shù)后1個(gè)月平均角膜內(nèi)皮細(xì)胞計(jì)數(shù)為（2446±218）個(gè)/mm2；17例患者術(shù)后無移植片移位、脫位發(fā)生，未發(fā)現(xiàn)明顯層間渾濁，除1例患者因自行停藥發(fā)生排斥反應(yīng)，給予及時(shí)用藥治療后恢復(fù)良好，余16例無嚴(yán)重并發(fā)癥發(fā)生。 結(jié)論：角膜內(nèi)皮移植術(shù)是治療大泡性角膜病變最為有效的手術(shù)方法；角膜內(nèi)皮移植術(shù)治療大泡性角膜病變術(shù)后視力恢復(fù)快、散光度數(shù)小、排斥反應(yīng)發(fā)生率低；大泡性角膜病變的主要病因是白內(nèi)障摘除、人工晶體植入。
[Abstract]:Objective: to summarize the clinical cases of patients with vesicular keratopathy and corneal endothelium transplantation from January 2009 to January 2012, and to analyze the age and cause of the disease. The clinical effect of corneal endothelial transplantation in the treatment of vesicular keratopathy and the prevention and treatment of adverse reactions were discussed. Methods: 17 cases (17 eyes) with corneal vesicular keratopathy and keratoendothelium transplantation were retrospectively studied. To summarize the clinical effect of corneal endothelial transplantation in the treatment of bullous keratopathy, the improvement of clinical symptoms and the recovery of visual acuity, and the comparison of corneal central thickness and transparency before and after operation. The decrease of endothelial cell count and complications after operation. Results: the most common causes of bullous keratopathy were cataract extraction and intraocular lens implantation. There were 9 cases (1 case with old ocular explosion injury), accounting for 52.9% of 17 cases of postoperative pain, corneal irritation symptoms disappeared. The corneal vesicles disappeared on the day of operation or on the first day after operation, and the cornea was smooth, transparent and close to normal in one week after operation. The mean central corneal thickness of 17 patients was (578 鹵30) 渭 m, which was significantly lower than that before operation. In 17 cases, the visual acuity was improved in 16 cases, except for 1 case of retinal contusion. The best corrected visual acuity (BCVA) was up to 0.3 at 1 week after operation and 0.6 at 1 month after operation, and the average astigmatism was (1.72 鹵0.87) D at 1 month after operation, and the number of endothelial cells in grafts decreased in varying degrees. Up to 1 month after operation, the average corneal endothelial cell count was (2446 鹵218,2mm ~ 2mm ~ (-2). There was no graft displacement, dislocation, and no obvious laminar opacity was found in 17 patients, except for one patient who had rejection due to drug withdrawal. The recovery was good after treatment, and no serious complications occurred in the remaining 16 cases. Conclusion: corneal endothelial transplantation is the most effective method for the treatment of bullous keratopathy, the visual acuity of corneal endothelial transplantation is fast, the astigmatism is small, and the incidence of rejection is low. The main cause of bullous keratopathy is cataract extraction and intraocular lens implantation.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R779.65

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