前部深板层角膜移植治疗偏中心角膜溃疡穿孔效果评估

摘要

目的 探讨偏中心角膜溃疡发生穿孔的患者采用前部深板层角膜移植(DLKP)治疗的有效性及可行性.方法 回顾性病例研究.总结观察2008年12月至2011年1月间,11例(11眼)多种原因导致的角膜溃疡穿孔、穿孔范围1.5～2.0 mm且穿孔部位在瞳孔边缘到角膜缘之间的患者行深板层角膜移植术,其中2例是独眼.术后对角膜移植片透明率、视力、眼压、角膜内皮细胞数量、排斥反应、角膜新生血管以及溃疡复发等进行评估.结果 随诊观察12～24个月,平均(17.5±3.7)个月.10眼角膜移植术后愈合良好(91％),无双前房形成,角膜移植片除穿孔区混浊外余均透明,恢复正常角膜厚度;1眼下方角膜溃疡者(患有类风湿和药物过敏)术后在溃疡处出现双前房,愈合不良导致植片混浊(9％).所有患者视力均有提高,术前视力:光感:3眼,手动:5眼,指数:2眼,0.01～0.05:1眼;术后视力:0.01～0.05:1眼,0.1～0.2:8眼,＞0.2:2眼.眼压正常.角膜内皮数为1862～2756个/mm2,平均(2286±293)个/mm2.未发生排斥反应,角膜溃疡无复发,未发生角膜移植片和层间新生血管化.结论 深板层角膜移植是治疗偏中心小范围角膜溃疡发生穿孔患者的有效方法.%Objective To demonstrate the efficacy of deep anterior lamellar keratoplasty for the treatment of eccentric corneal perforations.Methods It was a retrospective case series study.Deep anterior lamellar keratoplasty (DLKP) was performed on 11 patients with infected or noninfected corneal perforations from December 2008 to January 2011.The corneal perforations were located between the pupillary edge and limbus with diameters ranging from 1.5 mm to 2.0 mm.Postoperative visual acuity,intraocular pressure, endothelial cell density, transparency rate, corneal neovascularization, graft rejection and ulceration recurrence were recorded.Results Patients were followed postoperatively for 12-24 months (mean 17.5±3.7 months).The majority (10 eyes) had excellent engomphosis between the graft and recipient bed.Graft opacity was observed in 1 patient with rheumatoid arthritis and drug allergy due to the formation of a double anterior chamber at the ulceration site. All other patients had clear corneas, apart from the area of the original perforation. The integrity of the globe was restored in all 11 patients with an improvement in visual acuity (0.04 in one,and 0.1 or better in ten) and normal intraocular pressure.The average endothelial cell density after DLKP was 2286±293 cells/mm2. Immune graft rejections, ulceration recurrence and corneal neovascularization were not observed in any patient during the follow-up period. Conclusion DLKP is a safe and effective therapeutic measure in the management of patients with small eccentric corneal perforations.