發(fā)布時(shí)間：2018-04-17 20:28

  本文選題：深板層角膜移植 + 圓錐角膜　； 參考：《浙江大學(xué)》2014年博士論文

【摘要】：目的：評(píng)估全植床深板層角膜移植(FBDLK)修復(fù)急性水腫后與未急性水腫圓錐角膜的療效,分析急性水腫后與未急性水腫圓錐角膜患者FBDLK術(shù)后各項(xiàng)指標(biāo)的差異,評(píng)估角膜急性水腫對(duì)手術(shù)過(guò)程、術(shù)后并發(fā)癥、視力、內(nèi)皮細(xì)胞密度、角膜厚度的影響。 研究設(shè)計(jì)：回顧性研究 數(shù)據(jù)和方法：分析2011年4月至2014年3月于我院行FBDLK的圓錐角膜患者共108例131眼,納入急性水腫圓錐角膜組的共19例19眼,隨機(jī)選取未急性水腫圓錐角膜19例19眼組成對(duì)照組。觀察急性水腫患者水腫消退過(guò)程,觀察兩組患者手術(shù)過(guò)程,比較分析兩組患者的術(shù)后并發(fā)癥,術(shù)后1天、1月、6月、12月隨訪時(shí)視力、內(nèi)皮細(xì)胞密度、角膜厚度的變化情況。 結(jié)果：水腫組與對(duì)照組一般情況無(wú)顯著性差異。水腫組患者100%存在疤痕,累及后彈力膜；對(duì)照組36.8%存在疤痕,為淺中層疤痕,未累及后彈力膜。急性水腫患者起病至發(fā)生急性水腫時(shí)間間隔5.21±±4.25年。急性水腫期角膜厚度1325.11±345.691μm,水腫消退后角膜厚度454.56±96.45μm,水腫消退時(shí)長(zhǎng)107.89±25.72天,后彈力膜(DM)破口大小1.96±2.46mm2,后彈力膜與基質(zhì)層距離321.1±240.58-m。水腫組與對(duì)照組術(shù)中穿孔率78.95%、0%,前房注氣患者63.16%、0%,轉(zhuǎn)穿透性角膜移植0%、0%,手術(shù)時(shí)長(zhǎng)72.00±12.15分鐘、64.744±14.48分鐘。術(shù)后水腫組與對(duì)照組雙前房10.53%、0%,眼壓高5.26%、10.53%,繼發(fā)性青光眼5.26%、0%,排斥反應(yīng)0%、0%,植片失敗0%、0%。兩組患者術(shù)前、術(shù)后1天、術(shù)后1月、術(shù)后6月、術(shù)后12月裸眼視力分別為：水腫組0.075±0.084、0.086±0.087、0.198±0.115、0.275±0.215、0.396±0.189；對(duì)照組0.088±0.07、0.209±0.174、0.2694±0.171、0.299±0.140、0.361±0.178。各時(shí)間點(diǎn)最佳矯正視力分別為：水腫組0.1544±0.118、0.086±0.087、0.335±0.174、0.505±0207、0.563±0.199；對(duì)照組0.291±0.217、0.209±0.174、0.472±0.193、0.575±0.191、0.607±0.139。兩組患者術(shù)前、術(shù)后1月、術(shù)后6月、術(shù)后12月角膜內(nèi)皮細(xì)胞密度分別為：水腫組2397±454cells/mm2、1335±533cells/mm2.1434±432cells/mm2、1437±465cells/mm2;對(duì)照組2613±303cells/mm2,2276±286cells/mm2、2186±241cells/mm2、2198±234cells/mm2.兩組患者術(shù)后1月、6月、12月內(nèi)皮細(xì)胞丟失率分別為：水腫組45.2±29.1%、39.2±17.5%、35.3±34.5%；對(duì)照組11.44±12.0%、16.0±12.0%、15.0±9.1%。兩組患者術(shù)前、術(shù)后1天、術(shù)后1月、術(shù)后6月、術(shù)后12月角膜厚度分別為：水腫組459.00±86.85μm.828.00±138.28μm,611.23±97.98μm、528.18±61.38μm、509.67±38.45μm;對(duì)照組416.07±63.07μm.618.92±65.39μm、546.38±47.85μm、497.94±38.85μm、487.73±24.70μm。 結(jié)論：圓錐角膜急性水腫患者FBDLK術(shù)后短期視力低于未急性水腫患者,遠(yuǎn)期視力與未急性水腫患者類(lèi)似。急性水腫患者術(shù)后內(nèi)皮細(xì)胞丟失較未急性水腫患者多,但內(nèi)皮細(xì)胞數(shù)穩(wěn)定,殘留的內(nèi)皮細(xì)胞仍可維持角膜透明。急性水腫患者短期內(nèi)植片水腫較未急性水腫患者重,但遠(yuǎn)期角膜厚度與未急性水腫患者類(lèi)似�？紤]到角膜急性水腫對(duì)遠(yuǎn)期視力及植片水腫影響不大,且FBDLK術(shù)后內(nèi)皮細(xì)胞數(shù)穩(wěn)定,FBDLK手術(shù)應(yīng)用于圓錐角膜急性水腫后的患者是可行并值得推廣的。
[Abstract]:Objective: To evaluate the full bed deep lamellar keratoplasty (FBDLK) curative effect and no acute edema of keratoconus after repair of acute edema, differences with the indicators of FBDLK patients without acute edema of keratoconus after operation of acute edema after acute corneal edema on the assessment of surgical procedure, postoperative complications, visual acuity, endothelial cell density. The influence of corneal thickness.
Study design: a retrospective study
Data and methods: analysis of April 2011 to March 2014 in our hospital FBDLK patients with keratoconus were 108 cases 131 eyes included acute edema of keratoconus group a total of 19 eyes of 19 patients, randomly selected 19 cases of acute keratoconus without edema in 19 eyes as control group. Observation of edema in patients with acute edema subsided, observe two groups of patients during the operation, the comparative analysis of two groups of patients with postoperative complications, 1 days after the operation in January, June, December, follow-up visual acuity, endothelial cell density, the change of corneal thickness.
Results: the edema group and control group in general. No significant difference in 100% groups of patients with edema exist scar, involving the posterior elastic membrane; the control group 36.8% for superficial scar, scar, elastic membrane. After not involving the onset of acute edema to acute edema time interval was 5.21 + 4.25 years. Acute edema of corneal thickness 1325.11 + 345.691 m, edema of corneal thickness after 454.56 + 96.45 m, edema duration 107.89 + 25.72 days, Descemet's membrane (DM) tear size 1.96 + 2.46mm2, Descemet's membrane and matrix layer distance was 321.1 240.58-m. edema group and control group was 78.95%, the perforation rate 0%, anterior chamber gas injection in 63.16%, 0%, to penetrating keratoplasty in 0%, 0%, 72 + 12.15 minutes long during the operation, 64.744 + 14.48 minutes. The postoperative edema group and control group 0%, 10.53% double anterior chamber, intraocular pressure of 5.26%, 10.53%, 5.26% secondary glaucoma, 0%, 0%, 0%, rejection, graft failure 0%, two groups of 0%. patients before and after 1 days, after January, after June December, the postoperative uncorrected visual acuity were: edema group 0.075 + 0.084,0.086 + 0.087,0.198 + 0.115,0.275 + 0.215,0.396 + 0.189; control group 0.088 + 0.07,0.209 + 0.174,0.2694 + 0.171,0.299 + 0.140,0.361 + 0.178. at the time of the best corrected visual acuity respectively: edema group 0.1544 + 0.118,0.086 + 0.087,0.335 + 0.174,0.505 + 0207,0.563 + 0.199; control group 0.291 + 0.217,0.209 + 0.174,0.472 + 0.193,0.575 + 0.191,0.607 + 0.139. two groups of patients before and after surgery in January, after June, the density of corneal endothelial cells after December were edema group 2397 + 454cells/mm21335 + 533cells/mm2.1434 + 432cells/mm21437 + 465cells/mm2; the control group was 2613 + 303cells/mm22276 + 286cells/mm22186 + 241cells/mm22198 + 234cells/mm2. two group of patients after January, June, December, the rate of endothelial cell loss Respectively: edema group 45.2 + 29.1%, 39.2 + 17.5%, 35.3 + 34.5%; control group 11.44 + 12%, 16 + 12%, 15 + 9.1%. two groups of patients before operation, 1 days after surgery, after surgery in January, after June December, postoperative corneal thickness were: edema group 459 + 86.85 ^ m.828.00 138.28 + m, 611.23 + 97.98 m 528.18 + 61.38 m 509.67 + 38.45 m; control group 416.07 + 63.07 m.618.92 + 65.39 m 546.38 + 47.85 m 497.94 + 38.85 m 487.73 + 24.70 M.
Conclusion: keratoconus acute edema after FBDLK in patients with acute edema were not lower than short-term vision, long-term vision and acute edema were similar in patients with acute edema after surgery. Endothelial cell loss is not acute edema patients, but the number of endothelial cells, endothelial cells can maintain residual corneal transparency. Patients with acute edema short-term graft no edema of acute edema patients, but the long-term corneal thickness and no acute edema were similar. Considering the long-term vision and corneal edema on acute graft edema has little effect, and after FBDLK the number of endothelial cells, FBDLK surgery for keratoconus patients after acute edema is feasible and worthy of promotion.

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R779.6

【共引文獻(xiàn)】

中國(guó)期刊全文數(shù)據(jù)庫(kù) 前3條

1 Yan Lu;Yu-Hua Shi;Li-Ping Yang;Yi-Rui Ge;Xiang-Fei Chen;Yan Wu;Zhen-Ping Huang;;Femtosecond laser-assisted deep anterior lamellar keratoplasty for keratoconus and keratectasia[J];International Journal of Ophthalmology;2014年04期

2 Jin A Choi;Min A Lee;Man-Soo Kim;;Long-term outcomes of penetrating keratoplasty in keratoconus: analysis of the factors associated with final visual acuities[J];International Journal of Ophthalmology;2014年03期

3 賈亮;黃一飛;;樹(shù)突狀細(xì)胞在角膜移植免疫中的作用[J];解放軍醫(yī)學(xué)院學(xué)報(bào);2013年10期

中國(guó)博士學(xué)位論文全文數(shù)據(jù)庫(kù) 前4條

1 魏安基;二次穿透性角膜移植術(shù)后的臨床結(jié)果及角膜各項(xiàng)指標(biāo)的觀察[D];復(fù)旦大學(xué);2013年

2 田磊;在體角膜生物力學(xué)測(cè)量方法的建立與臨床應(yīng)用及京尼平兔角膜交聯(lián)的初步研究[D];中國(guó)人民解放軍醫(yī)學(xué)院;2014年

3 王旭;無(wú)力矩雙連續(xù)縫合法行光學(xué)性角膜移植的療效觀察[D];山東大學(xué);2014年

4 黃丹;Terrien角膜邊緣退行性變的臨床特征及冰凍保存供體的周邊深板層角膜移植或全角膜深板層角膜移植術(shù)的臨床療效分析[D];浙江大學(xué);2014年

中國(guó)碩士學(xué)位論文全文數(shù)據(jù)庫(kù) 前4條

1 蔡孟臻;深板層角膜移植術(shù)中后彈力膜穿孔特點(diǎn)臨床處理及預(yù)后[D];浙江大學(xué);2013年

2 廖聰玲;應(yīng)用國(guó)外捐獻(xiàn)的供體角膜組織行穿透性角膜移植的前瞻性研究[D];大連醫(yī)科大學(xué);2013年

3 孫鵬飛;角膜移植手術(shù)治療復(fù)雜角膜病變的臨床分析[D];山東大學(xué);2014年

4 張春曉;核黃素/UVA誘導(dǎo)的角膜交聯(lián)術(shù)治療晚期圓錐角膜的安全性和有效性評(píng)價(jià)[D];山東大學(xué);2014年

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本文編號(hào)：1765158