玻璃体视网膜手术联合穿透性角膜移植手术因素分析

摘要

目的:观察在临时人工角膜下经扁平部玻璃体视网膜手术联合穿透性角膜移植手术的疗效,探讨影响手术成功的因素.方法:回顾总结我院1996-12/2005-06行玻璃体视网膜手术联合穿透性角膜移植患者手术18例,主要分析病史,前后节功能恢复以及手术和手术并发症等因素.结果:13眼视力较前提高,其中视力在0.05～0.1之间者5眼;0.1～0.3者4眼,0.5者1眼;视力与术前无变化者5眼,10眼角膜植片透明,2眼再次做角膜移植手术,6眼出现角膜植片水肿、混浊,其中3眼为角膜排斥反应,3眼为角膜内皮失代偿.结论:尽管联合手术的视功能恢复是有限的,但至少提高了患者的生活质量.%AIM: to assess the effectiveness of a combined procedure ( pars plana vitrectomy with temporary keratoprosthesis, vitreoretinal surgery, and penetrating keratoplasty). in the complicated cases and the risk factors for the surgical failure.METHODS: Restrospectively reviewed charts of patients who underwent penetrating keratoplasty in combination with vitreoretinal surgery between 1990 and 2005, with a follow-up of 3mo to 9a. Analysis was focused on ocular history, indications for surgery, visual acuity (VA), anatomic results, and complications.RESULTS: 18 eyes had light perception or VA of hand motions only. The best-corrected VA improved during the first 3mo, increased in 72.2% of all eyes, remained unchanged in 27.78%, and no decreased. In 3 of 18 eyes (16.67%), VA was better than finger counting and hand motions, and nine eyes(50%) showed useful vision (0.05) postoperatively. 10 eyes showed a clear corneal graft (55.56%). 2 eyes needs the second keratoplasty, Bullous corneal edema was evident in 3 eyes, band keratopathy was evident in a 3 eyes. 10 patients were observed for more than 2a;6 had a clear graft (60%). Two eyes (11.11%) had silicone oil-corneal endothelium contact and all of these grafts failed.CONCLUSION: Although the functional outcome of a combined procedure is limited by primary and secondary tissue destruction, preserving ambulatory vision is possible and thus improves the quality of life, at least in patients with single remaining eyes.