12岁以下儿童穿透性角膜移植手术的临床分析

发布时间：2018-04-04 21:03

本文选题：儿童角膜移植　切入点：穿透性角膜移植　出处：《眼科》2017年04期

【摘要】：目的分析儿童穿透性角膜移植术的病因、手术方式、植片透明率、排斥反应发生率及影响排斥反应的相关因素。设计回顾性病例系列。研究对象北京同仁眼科中心2008年1月至2013年12月穿透性角膜移植手术的12岁以下患儿81例(81眼)。方法根据年龄分为婴幼组(0~3岁,49眼)和儿童组(4岁~12岁,32眼)。术后平均随访(38.72±21.46)个月。回顾患者的病历资料。主要指标患者年龄、术前诊断、手术方式、术后植片透明度。结果病因主要为先天性角膜混浊占82.72%;后天外伤性占6.17%,后天非外伤性占11.11%(其中感染性角膜炎3.70%,圆锥角膜角膜3.70%、移植术后植片失败3.70%)。先天性角膜混浊在婴幼组占93.88%,儿童组占65.63%(P0.01)。手术方式中单纯穿透性角膜移植术(PKP)占80.25%,其中婴幼组89.80%(44/49),儿童组75.00%(24/32)(P0.05)。末次随访时总体植片透明率85.19%,其中婴幼组81.63%(40/49),儿童组90.63%(29/32)(P0.05)。先天性因素者术后排斥率15.22%(7/46),后天性因素中活动性炎症导致角膜溃疡并穿孔(1/1)和植片失败进行再次角膜移植手术(3/3)的术后植片排斥率极高。结论 12岁以下儿童穿透性角膜移植的主要病因为先天性角膜混浊。虽然儿童角膜移植难度大,但仍具备一定的成功条件。儿童穿透性角膜移植植片存活率有所提高。
[Abstract]:Objective to analyze the etiology, operative method, graft transparency rate, rejection rate and related factors of penetrating keratoplasty in children.Design retrospective case series.Participants 81 children under 12 years of age who underwent penetrating keratoplasty from January 2008 to December 2013 were enrolled in the study.Methods according to the age, the infant group was divided into 3 years old group (49 eyes) and the children group (12 years old, 32 eyes).The average follow-up was 38.72 卤21.46 months.The patient's medical records were reviewed.Main outcome measures Age, preoperative diagnosis, operative method, transparency of grafts after operation.Results the main etiology was congenital corneal opacity (82.72), postnatal trauma (6.17), acquired non-traumatic (11.11) (infective keratitis 3.70, keratoconus 3.70), graft failure 3.70 after transplantation.Congenital corneal opacity was 93.88 in infantile group and 65.63 in infantile group.PKP of penetrating keratoplasty was 80.25%, including 89.80% in infant group and 75.00% in child group.At the last follow-up, the overall transparency rate of grafts was 85.19, including 81.63% 40 / 49% in infant group and 90.63% 32% in children group (P 0.05).The postoperative rejection rate of congenital factors was 15.2222 / 7 / 46, and the rejection rate of corneal ulcer and perforation caused by active inflammation in acquired factors was 1 / 1 / 1) and the rejection rate of graft was 3 / 3 / 3).Conclusion congenital corneal opacity is the main cause of penetrating keratoplasty in children under 12 years old.Although corneal transplantation is difficult in children, it still has certain successful conditions.The survival rate of penetrating keratoplasty in children was improved.
【作者单位】：首都医科大学附属北京同仁医院北京同仁眼科中心眼科学与视觉科学北京市重点实验室;
【分类号】：R779.65

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