本文選題：治療性角膜移植 + 光學(xué)性角膜移植��； 參考：《浙江大學(xué)》2010年碩士論文

【摘要】： 目的：回顧性總結(jié)采用冰凍保存角膜行治療性穿透性角膜移植(Therapeautic penetrating keratoplasty, T-PKP)后再度行光學(xué)性穿透性角膜移植(Optical Penetrating keratoplasty, O-PKP)的臨床療效。 資料與方法：回顧1998年10月至2008年10月在我院就診,采用冰凍保存角膜行T-PKP,術(shù)后再次接受O-PKP治療,且術(shù)后規(guī)律隨訪超過(guò)6個(gè)月的所有患者的病歷資料,分析其術(shù)后植片存活狀態(tài),并發(fā)癥,內(nèi)皮細(xì)胞密度變化和術(shù)后視力轉(zhuǎn)歸等情況。 結(jié)果：符合納入標(biāo)準(zhǔn)的病例共44例(44眼),在O-PKP術(shù)后中位數(shù)隨訪時(shí)間為19個(gè)月(6-76個(gè)月)的過(guò)程中,14眼發(fā)生植片失代償,植片生存率68.2%,透明植片估計(jì)生存均值49.8±5.0月。植片失代償?shù)奈ｋU(xiǎn)因素中,O-PKP術(shù)后排斥反應(yīng)的相對(duì)危險(xiǎn)度為20.10(P=0.01),術(shù)后繼發(fā)性青光眼的相對(duì)危險(xiǎn)度為6.72(P=0.040.05),在統(tǒng)計(jì)學(xué)上均有相關(guān)性,但年齡、T-PKP術(shù)前是否發(fā)生角膜穿孔、T-PKP植片大小、O-PKP是否聯(lián)合白內(nèi)障手術(shù)、O-PKP術(shù)后是否再行眼內(nèi)手術(shù)等因素在統(tǒng)計(jì)學(xué)上無(wú)相關(guān)性。T-PKP后繼發(fā)性青光眼予藥物及手術(shù)治療后眼壓仍高者15眼(34.1%),而O-PKP術(shù)后僅5眼(11.4%)發(fā)生繼發(fā)性青光眼,兩者比較有顯著性差異(P0.05),上述15眼術(shù)前平均眼壓38.3±9.0mmHg,經(jīng)O-PKP粘連房角分離及眼前段重建,術(shù)后1月、6月、12月平均眼壓降至17.7±8.9 mmHg、18.0±7.5 mmHg、17.1±6.5mmHg,較術(shù)前明顯降低,兩者比較在統(tǒng)計(jì)學(xué)上有高度顯著性差異(P0.01)。O-PKP術(shù)后23眼(52.3%)發(fā)生一過(guò)性排斥反應(yīng),經(jīng)藥物治療后均控制,但13眼最終發(fā)生植片失代償。O-PKP術(shù)后17眼晶體尚透明,予保留,其中12眼(70.6%)術(shù)后出現(xiàn)并發(fā)性白內(nèi)障,透明晶體估計(jì)生存均值為24.1±3.7月。O-PKP術(shù)后12月總體內(nèi)皮細(xì)胞密度較術(shù)后1月下降25.2±35.6%(P0.01)。O-PKP術(shù)后1年中位數(shù)最佳矯正視力(best corrected visual acurity,BCVA)為0.4,末次隨訪中位數(shù)BCVA為0.15,其中19眼末次隨訪BCVA0.4。 結(jié)論：采用冰凍保存的角膜行T-PKP,在治愈原發(fā)疾病并保全眼球后,再行O-PKP可獲得理想的植片生存率,并發(fā)癥少,視力恢復(fù)良好。再度O-PKP植片生存的危險(xiǎn)因素為術(shù)后排斥反應(yīng)和繼發(fā)性青光眼。再度O-PKP對(duì)T-PKP術(shù)后的繼發(fā)性青光眼有一定程度上的治療作用。
[Abstract]:Objective: to summarize the clinical effect of optical penetrating keratoplasty (O-PKP) after Therapeautic penetrating keratoplasty (T-PKP). Materials and methods: from October 1998 to October 2008, all patients with frozen corneal preservation were treated with T-PKP and received O-PKP treatment again, and the patients were followed up regularly for more than 6 months. The survival status, complications, changes of endothelial cell density and postoperative visual acuity were analyzed. Results: 44 cases (44 eyes) met the inclusion criteria. The median follow-up time of O-PKP was 19 months (6-76 months). The graft decompensation occurred in 14 eyes, the survival rate was 68.2 and the mean survival of transparent graft was 49.8 鹵5.0 months. Among the risk factors of graft decompensation, the relative risk of rejection was 20.10 (P0.01) for post-operative rejection and 6.72 (P0.040.05) for postoperative secondary glaucoma. However, there was no statistical correlation between the age of T-PKP and the size of T-PKP graft and the combination of O-PKP and intraocular surgery after cataract surgery. The pressure was still high in 15 eyes (34.1%), but only 5 eyes (11.4%) developed secondary glaucoma after O-PKP. There was significant difference between the two groups (P0.05). The mean intraocular pressure (IOP) of the 15 eyes was 38.3 鹵9.0mmHg. after O-PKP conglutination angle separation and anterior segment reconstruction, the mean IOP decreased to 17.7 鹵8.9 mmHg 18.0 鹵7.5 mmHg 17.1 鹵6.5 mmHg in 1 month, 6 months and 12 months after operation. There was a statistically significant difference (P0.01) .O-PKP in 23 eyes (52.3%) with transient rejection, which was controlled after drug therapy, but 17 eyes after graft decompensation (.O-PKP) were still transparent and preserved. Among them, 12 eyes (70.6%) developed complicated cataract after operation. The mean survival value of transparent lens was 24.1 鹵3.7 months. The total endothelial cell density decreased by 25.2 鹵35.6% (P0.01). O-PKP decreased by 25.2 鹵35.6% (P0.01). The median corrected visual acuity (best corrected visual acurityBCVA) in one year after operation was 0.4, and the median BCVA at the last follow-up was 0.15. among them, 19 eyes were followed up at the last time. Conclusion: the frozen cornea were treated with T-PKP. After curing the primary diseases and preserving the eyeball, O-PKP could obtain the ideal survival rate of grafts, fewer complications and better visual acuity. The risk factors for survival of O-PKP graft were postoperative rejection and secondary glaucoma. Re-O-PKP has a certain therapeutic effect on secondary glaucoma after T-PKP.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R779.65

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相關(guān)期刊論文 前2條

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2 周萍,姚玉峰,李修義;口服阿昔洛韋在單皰病毒性角膜炎行角膜移植術(shù)后的應(yīng)用[J];中國(guó)實(shí)用眼科雜志;2005年04期

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