新鲜与甘油冷冻保存角膜供体应用于深板层角膜移植治疗化脓性角膜炎

摘要

目的 对比新鲜与甘油冷冻保存角膜供体对深板层角膜移植治疗化脓性角膜炎术后临床恢复的影响.方法 回顾性病例研究.2011年1月至2012年8月,在山东省眼科医院成功施行深板层角膜移植术(DALK)的化脓性角膜炎患者32例(32眼).根据供体保存方式,分为新鲜供体组(FCT)13例与甘油供体组(GCCT)19例.采集供体资料,记录术后并发症、植片情况及屈光状态等.采用独立样本t检验对数据进行分析.结果 术后角膜上皮愈合完整时间,新鲜供体组为(3.8±2.1)d,甘油供体组为(7.3±2.7)d,差异有统计学意义(t=-3.764,P＜0.05).植片水肿消退时间,新鲜供体组为(5.7±2.6)d,甘油供体组为(10.4±3.0)d,差异有统计学意义(t=-4.348,P＜0.01).随访期内甘油供体组有3例发生植片上皮缺损,对症治疗后植片上皮缺损愈合.23例(23眼,除外白内障及先天性弱视)术后最佳矫正视力均恢复至20/63～20/25,新鲜供体组和甘油供体组的平均视力分别为(0.25±0.12)logMAR、(0.28±0.17)logMAR,2组差异无统计学意义(t=-1.428,P＞0.05).结论 甘油保存供体用于DALK术治疗化脓性角膜炎,角膜上皮愈合及角膜水肿消退时间较新鲜供体慢.及时合理处理并发症,可以获得与新鲜供体相似的屈光愈后.%Objective To compare the outcomes of using fresh and glycerin-cryopreserved corneal tissue in treating purulent keratitis with deep anterior lamellar keratoplasty.Methods This was a retrospective case series study.Thirty-two patients (32 eyes) with purulent keratitis successfully underwent deep anterior lamellar keratoplasty (DALK) in Shandong Eye Hospital from January 2011 to August 2012.Based on the method for preserving corneal tissue,all patients were divided into a fresh corneal tissue (FCT) group (13 cases) and a glycerin-cryopreserved corneal tissue (GCCT) group (19 cases).Data on donor,complications,graft status and visual outcome were collected.An independent samples t test analysis was used to analyze the data.Results The amount of time for the epithelium graft to heal in the FCT group and GCCT group were 3.8±2.2 d and 7.3±2.7 d (t=-3.764,P＜0.05).The amount of time for the graft edema to disappear in the FCT group and GCCT group were 5.7±2.6 d and 10.4±3.0 d (t=-4.348,P＜0.01).In the follow-up phase,3 cases of graft epithelium defects occurred in the GCCT group and were healed with symptomatic treatment.After the surgery,the best corrected visual acuity (BCVA) of 23 patients (excluding cataract and congenital amblyopia) improved to 20/63-20/25,the mean BCVAs of the FCT and GCCT groups were 0.25±0.12 logMAR and 0.28±0.17 logMAR,respectively (t=-1.428,P＞0.05).Conclusion When glycerin-cryopreserved corneal tissue is used to treat purulent keratitis in DALK,the amount of time for the epithelium to heal and corneal edema to disappear took longer than with fresh corneal tissue.If potential or actual complications in GCCT group were treated in a timely and reasonable manner,similar outcomes would be obtained as for the FCT group.