角膜内皮移植术治疗大泡性角膜病变的临床观察

发布时间：2018-07-20 21:25

【摘要】：目的：总结我院自2009年1月至2012年1月期间患大泡性角膜病变并行角膜内皮移植术且有术后定期随访患者的临床病例，对患者的年龄、发病原因、术前患眼情况及伴随症状等与术后恢复情况的关系进行分析，探讨角膜内皮移植术治疗大泡性角膜病变的临床效果、不良反应的预防及处理。方法：对患大泡性角膜病变并行角膜内皮移植术的17例(17只眼)进行回顾性研究。总结角膜内皮移植术治疗大泡性角膜病变的临床效果，术后临床症状的改善及视力恢复情况，术前术后角膜中央厚度及透明性的对比，术后内皮细胞计数的下降以及并发症情况。结果：大泡性角膜病变最常见病因为白内障摘除、人工晶状体植入术后，共9例（其中有1例合并陈旧性眼爆炸伤），占总数52.9%；17例患者术后当日疼痛、角膜刺激症状消失，术后当日或术后第一日角膜大泡消失，至术后一周角膜光滑、透明，厚度接近正常，本组17例患者术后一周角膜中央厚度平均为（578±30）μm，较术前明显降低；17例患者中除1例视网膜挫伤，术后视力无提高外，，其余16例视力均有不同程度提高，术后1周最佳矫正视力最高达0.3，至术后1个月最佳矫正视力最高达0.6，术后1个月平均散光为（1.72±0.87）D；术后植片内皮细胞计数均有不同程度下降，至术后1个月平均角膜内皮细胞计数为（2446±218）个/mm2；17例患者术后无移植片移位、脱位发生，未发现明显层间浑浊，除1例患者因自行停药发生排斥反应，给予及时用药治疗后恢复良好，余16例无严重并发症发生。结论：角膜内皮移植术是治疗大泡性角膜病变最为有效的手术方法；角膜内皮移植术治疗大泡性角膜病变术后视力恢复快、散光度数小、排斥反应发生率低；大泡性角膜病变的主要病因是白内障摘除、人工晶体植入。
[Abstract]:Objective: to summarize the clinical cases of patients with vesicular keratopathy and corneal endothelium transplantation from January 2009 to January 2012, and to analyze the age and cause of the disease. The clinical effect of corneal endothelial transplantation in the treatment of vesicular keratopathy and the prevention and treatment of adverse reactions were discussed. Methods: 17 cases (17 eyes) with corneal vesicular keratopathy and keratoendothelium transplantation were retrospectively studied. To summarize the clinical effect of corneal endothelial transplantation in the treatment of bullous keratopathy, the improvement of clinical symptoms and the recovery of visual acuity, and the comparison of corneal central thickness and transparency before and after operation. The decrease of endothelial cell count and complications after operation. Results: the most common causes of bullous keratopathy were cataract extraction and intraocular lens implantation. There were 9 cases (1 case with old ocular explosion injury), accounting for 52.9% of 17 cases of postoperative pain, corneal irritation symptoms disappeared. The corneal vesicles disappeared on the day of operation or on the first day after operation, and the cornea was smooth, transparent and close to normal in one week after operation. The mean central corneal thickness of 17 patients was (578 卤30) 渭 m, which was significantly lower than that before operation. In 17 cases, the visual acuity was improved in 16 cases, except for 1 case of retinal contusion. The best corrected visual acuity (BCVA) was up to 0.3 at 1 week after operation and 0.6 at 1 month after operation, and the average astigmatism was (1.72 卤0.87) D at 1 month after operation, and the number of endothelial cells in grafts decreased in varying degrees. Up to 1 month after operation, the average corneal endothelial cell count was (2446 卤218,2mm ~ 2mm ~ (-2). There was no graft displacement, dislocation, and no obvious laminar opacity was found in 17 patients, except for one patient who had rejection due to drug withdrawal. The recovery was good after treatment, and no serious complications occurred in the remaining 16 cases. Conclusion: corneal endothelial transplantation is the most effective method for the treatment of bullous keratopathy, the visual acuity of corneal endothelial transplantation is fast, the astigmatism is small, and the incidence of rejection is low. The main cause of bullous keratopathy is cataract extraction and intraocular lens implantation.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.65

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