【摘要】：目的探討非化學(xué)傷角膜病患者接受角膜移植手術(shù)后角膜植片潰瘍的臨床特征及相關(guān)的危險因素。方法回顧性分析我院2010年01月至2016年01月接受角膜移植手術(shù)的角膜病(眼部化學(xué)傷除外)患者1354例(1379眼),按照術(shù)后是否發(fā)生角膜植片潰瘍分為植片潰瘍組與非植片潰瘍組,探討角膜移植術(shù)后植片潰瘍組患者的臨床特征,并采用t檢驗、x2檢驗和Logistic回歸方程對角膜移植術(shù)后患者植片潰瘍發(fā)生的危險因素進(jìn)行分析。結(jié)果1354例患者中,男性892例,女性462例,年齡平均44.89±18.45歲(0.25~86歲)。植片潰瘍組共91例(91眼),平均年齡51.04±17.04歲(1~82歲);非植片潰瘍組共1263例(1288眼),平均年齡為44.45±18.47歲(0.25~86歲),兩組間平均年齡的差異有統(tǒng)計學(xué)意義(P0.05)。兩組男女比例相同,均為1.9:1。植片潰瘍多發(fā)生于角膜移植術(shù)后1年內(nèi)(59例,64.8%)。15例(16.5%)合并前房積膿,73例(80.2%)浸潤達(dá)深基質(zhì),4例(4.4%)發(fā)展為角膜植片穿孔。植片潰瘍形態(tài)以圓形、類圓形為主(54例,59.3%),多數(shù)不累及植床;潰瘍可位于植片中央(46例,50.5%)或植片周邊(45例,49.5%),周邊部植片潰瘍長徑一般≤4mm(40/45,88.89%)。角膜移植術(shù)后植片潰瘍的發(fā)生率為6.60%(91/1379),其中穿透性角膜移植術(shù)后植片潰瘍發(fā)生率為5.90%(62/1050),板層角膜移植術(shù)為8.81%(29/329),差異無統(tǒng)計學(xué)意義(P=0.074)。91例植片潰瘍中44例(48.4%)診斷為植片感染(細(xì)菌25例,真菌19例);21例(23.1%)由干眼、MGD、持續(xù)上皮缺損、縫線刺激等眼表異常導(dǎo)致;13例(14.3%)為HSK復(fù)發(fā),8例(8.8%)為免疫性角膜炎復(fù)發(fā),5例(5.5%)是植片慢性失功。植片感染的致病菌以表皮葡萄球菌為主。多因素Logistic回歸分析顯示,持續(xù)性植片上皮缺損(OR=6.600,P0.01)、HSK(OR=3.274,P0.01)、植片直徑≥9mm(OR=2.180,P0.05)、非新鮮角膜供體(OR=1.940,P0.05)和年齡(OR=1.015,P0.05)是角膜移植術(shù)后植片潰瘍的危險因素,患者職業(yè)、是否合并糖尿病、術(shù)后免疫排斥、是否聯(lián)合手術(shù)與植片潰瘍的發(fā)生無明顯相關(guān)性。結(jié)論角膜移植術(shù)后植片潰瘍發(fā)生率約6.6%,多發(fā)生于術(shù)后1年內(nèi);植片感染是植片潰瘍的首要原因,最主要的致病菌為表皮葡萄球菌;持續(xù)性植片上皮缺損,原發(fā)病為HSK、植片直徑≥9mm、非新鮮角膜供體和年齡是植片潰瘍形成的危險因素;植片潰瘍病因復(fù)雜、臨床表現(xiàn)多樣,應(yīng)盡早明確潰瘍發(fā)生的原因及性質(zhì),有針對性地對因?qū)ΠY治療。
[Abstract]:Objective to investigate the clinical features and risk factors of corneal graft ulcers after keratoplasty in patients with non-chemical keratopathy. Methods 1354 patients (1379 eyes) who underwent keratoplasty from January 2010 to January 2016 were analyzed retrospectively. According to whether corneal graft ulcer occurred or not, they were divided into two groups: graft ulcer group and non-graft ulcer group. To investigate the clinical characteristics of patients with corneal graft ulcer after keratoplasty. T test, x2 test and Logistic regression equation were used to analyze the risk factors of the occurrence of graft ulcer after keratoplasty. Results there were 892 males and 462 females with an average age of 44.89 鹵18.45 years (0.25 鹵86 years). 91 cases (91 eyes) were treated with graft ulcer, the mean age was 51.04 鹵17.04 years (1 / 82 years). There were 1263 patients (1288 eyes) in non-graft ulcer group with an average age of 44.45 鹵18.47 years (0.25 鹵86 years). There was a significant difference in mean age between the two groups (P0.05). The ratio of men to women in both groups was the same, which was 1.9. Most of the graft ulcers occurred within one year after keratoplasty (59 cases, 64.8%), 15 cases (16.5%) complicated with anterior chamber pus, 73 cases (80.2%) infiltrated deep stroma, 4 cases (4.4%) developed corneal graft perforation. The shape of graft ulcer was round and round (54 cases, 59.3%), and most of them were not involved in the implantation bed. The ulcers could be located in the center of the graft (46 cases, 50.5%) or around the graft (45 cases, 49.5%). The long diameter of the graft ulcer in the peripheral part was generally 鈮，

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