穿透性角膜移植術后并發(fā)性白內障臨床研究
發(fā)布時間：2018-07-23 17:26
【摘要】：目的 觀察并分析穿透性角膜移植術(PKP)術的原發(fā)病因與并發(fā)性白內障發(fā)生的時間以及PKP術后并發(fā)性白內障患者行囊外摘除術(ECCE)和超聲乳化吸除術(PHACO)的療效和安全性。 臨床資料和方法 收集自2011年1月至2012年12月間在山東大學齊魯醫(yī)院行穿透性角膜移植術后并發(fā)性白內障摘除+人工晶體植入術并且定期隨訪的24例患者的臨床資料,并進行回顧性分析。 PKP術后并發(fā)性白內障患者24例,分為ECCE禾PHACO兩組,行相應的術前檢查和準備后分別行囊外摘除和超聲乳化吸除術+人工晶體植入術。定期隨訪,記錄并對比分析兩組患者術后視力、角膜內皮細胞計數(shù)和角膜散光情況。 結果 PKP病因與并發(fā)性白內障發(fā)生的時間：感染性角膜病變13例(54.17%),其中PKP術后并發(fā)性白內障發(fā)生時間為1年以內的11例(84.62%),1年以上的2例(15.38%)；外傷所致角膜白斑5例(20.83%),其中PKP術后并發(fā)性白內障發(fā)生時間為1年以內的3例(60%),1年以上的2例(40%)；角膜移植排斥反應4例(16.67%),其中PKP術后并發(fā)性白內障發(fā)生時間為1年以內的3例(75%),1年以上的1例(25%)；角膜變性或營養(yǎng)不良、大泡性角膜病變各1例(4.17%),并發(fā)性白內障均發(fā)生于PKP術后1年以內。 ECCE組和超聲乳化組的療效和安全可行性對比：ECCE和超聲乳化吸除術兩組24例術前和術后3個月最佳矯正視力存在統(tǒng)計學差異,術后3個月最佳矯正視力大等于0.4者所占比例分別為ECCE組80%和超聲乳化組78.57%,經統(tǒng)計學檢驗無差異。兩組術后3個月角膜內皮細胞丟失率分別為超聲乳化組(10.01±2.8)%和ECCE組(7.8+2.4)%,兩組之間存在統(tǒng)計學差異。兩組術后3個月角膜散光度數(shù)分別為超聲乳化組(4.17±2.10)D和ECCE組(5.17±2.19)D,經統(tǒng)計學檢驗存在差異。 結論 PKP術后并發(fā)性白內障患者中最常見的PKP原發(fā)病因是感染性角膜炎,術后并發(fā)性白內障多發(fā)生于PKP術后1年以內,各種PKP病因對PKP術后并發(fā)性白內障發(fā)生時間無明顯影響。 PKP術后并發(fā)性白內障患者行ECCE和白內障超聲乳化吸除術的療效均十分顯著,安全性均令人滿意。其中超聲乳化手術對角膜內皮的損傷要大于囊外摘除術,但術后散光較囊外摘除術小。
[Abstract]:Objective to observe and analyze the primary cause and time of complicated cataract in penetrating keratoplasty (PKP) and the efficacy and safety of extracapsular extraction (ECCE) and phacoemulsification (PHACO) in patients with cataract after PKP. Methods from January 2011 to December 2012, 24 patients underwent cataract extraction and intraocular lens implantation after penetrating keratoplasty in Qilu Hospital, Shandong University, and were followed up regularly. 24 patients with cataract after PKP were divided into two groups: ECCE and PHACO. The patients underwent extracapsular extirpation and phacoemulsification intraocular lens implantation respectively. The postoperative visual acuity, corneal endothelial cell count and corneal astigmatism were recorded and compared between the two groups. Results the etiology of PKP and the time of complicated cataract: 13 cases (54.17%) were infective keratopathy, of which 11 cases (84.62%) were complicated with cataract within one year after PKP, and 2 cases (15.38%) were over one year. There were 5 cases (20.83%) of corneal leukoplakia caused by trauma, of which 3 cases (60%) were complicated with cataract within one year after PKP, and 2 cases (40%) more than one year. Corneal allograft rejection was found in 4 cases (16.67%), including 3 cases (75%) with cataract after PKP, 1 case (25%) with corneal degeneration or malnutrition, 1 case (25%) with corneal allograft rejection, 3 cases (75%) with cataract after PKP, and 1 case (25%) with corneal allograft rejection. One case (4.17%) of bullous keratopathy occurred within 1 year after PKP. The curative effect and safety feasibility of ECCE group and phacoemulsification group were compared with 24 cases of preoperation and operation in two groups: Ecce and phacoemulsification. The best corrected visual acuity (BCVA) was statistically different after 3 months. Three months after operation, the proportion of the patients with the best corrected visual acuity equal to 0.4 was 80% in the ECCE group and 78.57 in the phacoemulsification group. There was no statistical difference between the two groups. The loss rate of corneal endothelial cells was (10.01 鹵2.8)% in phacoemulsification group and (7.82.4)% in ECCE group at 3 months after operation, and there was significant difference between the two groups. The corneal astigmatism was (4.17 鹵2.10) D in phacoemulsification group and (5.17 鹵2.19) D in ECCE group 3 months after operation. Conclusion Infectious keratitis is the most common cause of PKP in patients with cataract after PKP. The most common cause of complicated cataract after PKP is less than 1 year after PKP. The effect of ECCE and phacoemulsification on the occurrence time of cataract after PKP was significant and the safety was satisfactory. Phacoemulsification caused more damage to corneal endothelium than extracapsular extirpation, but astigmatism was smaller than extracapsular extirpation.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R779.65
本文編號：2140115
[Abstract]:Objective to observe and analyze the primary cause and time of complicated cataract in penetrating keratoplasty (PKP) and the efficacy and safety of extracapsular extraction (ECCE) and phacoemulsification (PHACO) in patients with cataract after PKP. Methods from January 2011 to December 2012, 24 patients underwent cataract extraction and intraocular lens implantation after penetrating keratoplasty in Qilu Hospital, Shandong University, and were followed up regularly. 24 patients with cataract after PKP were divided into two groups: ECCE and PHACO. The patients underwent extracapsular extirpation and phacoemulsification intraocular lens implantation respectively. The postoperative visual acuity, corneal endothelial cell count and corneal astigmatism were recorded and compared between the two groups. Results the etiology of PKP and the time of complicated cataract: 13 cases (54.17%) were infective keratopathy, of which 11 cases (84.62%) were complicated with cataract within one year after PKP, and 2 cases (15.38%) were over one year. There were 5 cases (20.83%) of corneal leukoplakia caused by trauma, of which 3 cases (60%) were complicated with cataract within one year after PKP, and 2 cases (40%) more than one year. Corneal allograft rejection was found in 4 cases (16.67%), including 3 cases (75%) with cataract after PKP, 1 case (25%) with corneal degeneration or malnutrition, 1 case (25%) with corneal allograft rejection, 3 cases (75%) with cataract after PKP, and 1 case (25%) with corneal allograft rejection. One case (4.17%) of bullous keratopathy occurred within 1 year after PKP. The curative effect and safety feasibility of ECCE group and phacoemulsification group were compared with 24 cases of preoperation and operation in two groups: Ecce and phacoemulsification. The best corrected visual acuity (BCVA) was statistically different after 3 months. Three months after operation, the proportion of the patients with the best corrected visual acuity equal to 0.4 was 80% in the ECCE group and 78.57 in the phacoemulsification group. There was no statistical difference between the two groups. The loss rate of corneal endothelial cells was (10.01 鹵2.8)% in phacoemulsification group and (7.82.4)% in ECCE group at 3 months after operation, and there was significant difference between the two groups. The corneal astigmatism was (4.17 鹵2.10) D in phacoemulsification group and (5.17 鹵2.19) D in ECCE group 3 months after operation. Conclusion Infectious keratitis is the most common cause of PKP in patients with cataract after PKP. The most common cause of complicated cataract after PKP is less than 1 year after PKP. The effect of ECCE and phacoemulsification on the occurrence time of cataract after PKP was significant and the safety was satisfactory. Phacoemulsification caused more damage to corneal endothelium than extracapsular extirpation, but astigmatism was smaller than extracapsular extirpation.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R779.65
【參考文獻】
相關期刊論文 前3條
1 劉偉;何書喜;;白內障術后散光的研究進展[J];國際眼科雜志;2008年02期
2 孫堂勝;;糖尿病患者白內障術后的急性前房反應[J];國際眼科雜志;2009年01期
3 劉惠娟;曾強;;白內障冷超聲乳化手術臨床療效分析[J];中國全科醫(yī)學;2010年15期
，本文編號：2140115
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