角膜移植术后植片溃疡的原因及危险因素分析
发布时间：2019-04-07 17:23
【摘要】：目的探讨非化学伤角膜病患者接受角膜移植手术后角膜植片溃疡的临床特征及相关的危险因素。方法回顾性分析我院2010年01月至2016年01月接受角膜移植手术的角膜病(眼部化学伤除外)患者1354例(1379眼),按照术后是否发生角膜植片溃疡分为植片溃疡组与非植片溃疡组,探讨角膜移植术后植片溃疡组患者的临床特征,并采用t检验、x2检验和Logistic回归方程对角膜移植术后患者植片溃疡发生的危险因素进行分析。结果1354例患者中,男性892例,女性462例,年龄平均44.89±18.45岁(0.25~86岁)。植片溃疡组共91例(91眼),平均年龄51.04±17.04岁(1~82岁);非植片溃疡组共1263例(1288眼),平均年龄为44.45±18.47岁(0.25~86岁),两组间平均年龄的差异有统计学意义(P0.05)。两组男女比例相同,均为1.9:1。植片溃疡多发生于角膜移植术后1年内(59例,64.8%)。15例(16.5%)合并前房积脓,73例(80.2%)浸润达深基质,4例(4.4%)发展为角膜植片穿孔。植片溃疡形态以圆形、类圆形为主(54例,59.3%),多数不累及植床;溃疡可位于植片中央(46例,50.5%)或植片周边(45例,49.5%),周边部植片溃疡长径一般≤4mm(40/45,88.89%)。角膜移植术后植片溃疡的发生率为6.60%(91/1379),其中穿透性角膜移植术后植片溃疡发生率为5.90%(62/1050),板层角膜移植术为8.81%(29/329),差异无统计学意义(P=0.074)。91例植片溃疡中44例(48.4%)诊断为植片感染(细菌25例,真菌19例);21例(23.1%)由干眼、MGD、持续上皮缺损、缝线刺激等眼表异常导致;13例(14.3%)为HSK复发,8例(8.8%)为免疫性角膜炎复发,5例(5.5%)是植片慢性失功。植片感染的致病菌以表皮葡萄球菌为主。多因素Logistic回归分析显示,持续性植片上皮缺损(OR=6.600,P0.01)、HSK(OR=3.274,P0.01)、植片直径≥9mm(OR=2.180,P0.05)、非新鲜角膜供体(OR=1.940,P0.05)和年龄(OR=1.015,P0.05)是角膜移植术后植片溃疡的危险因素,患者职业、是否合并糖尿病、术后免疫排斥、是否联合手术与植片溃疡的发生无明显相关性。结论角膜移植术后植片溃疡发生率约6.6%,多发生于术后1年内;植片感染是植片溃疡的首要原因,最主要的致病菌为表皮葡萄球菌;持续性植片上皮缺损,原发病为HSK、植片直径≥9mm、非新鲜角膜供体和年龄是植片溃疡形成的危险因素;植片溃疡病因复杂、临床表现多样,应尽早明确溃疡发生的原因及性质,有针对性地对因对症治疗。
[Abstract]:Objective to investigate the clinical features and risk factors of corneal graft ulcers after keratoplasty in patients with non-chemical keratopathy. Methods 1354 patients (1379 eyes) who underwent keratoplasty from January 2010 to January 2016 were analyzed retrospectively. According to whether corneal graft ulcer occurred or not, they were divided into two groups: graft ulcer group and non-graft ulcer group. To investigate the clinical characteristics of patients with corneal graft ulcer after keratoplasty. T test, x2 test and Logistic regression equation were used to analyze the risk factors of the occurrence of graft ulcer after keratoplasty. Results there were 892 males and 462 females with an average age of 44.89 卤18.45 years (0.25 卤86 years). 91 cases (91 eyes) were treated with graft ulcer, the mean age was 51.04 卤17.04 years (1 / 82 years). There were 1263 patients (1288 eyes) in non-graft ulcer group with an average age of 44.45 卤18.47 years (0.25 卤86 years). There was a significant difference in mean age between the two groups (P0.05). The ratio of men to women in both groups was the same, which was 1.9. Most of the graft ulcers occurred within one year after keratoplasty (59 cases, 64.8%), 15 cases (16.5%) complicated with anterior chamber pus, 73 cases (80.2%) infiltrated deep stroma, 4 cases (4.4%) developed corneal graft perforation. The shape of graft ulcer was round and round (54 cases, 59.3%), and most of them were not involved in the implantation bed. The ulcers could be located in the center of the graft (46 cases, 50.5%) or around the graft (45 cases, 49.5%). The long diameter of the graft ulcer in the peripheral part was generally 鈮，
本文编号：2454265
[Abstract]:Objective to investigate the clinical features and risk factors of corneal graft ulcers after keratoplasty in patients with non-chemical keratopathy. Methods 1354 patients (1379 eyes) who underwent keratoplasty from January 2010 to January 2016 were analyzed retrospectively. According to whether corneal graft ulcer occurred or not, they were divided into two groups: graft ulcer group and non-graft ulcer group. To investigate the clinical characteristics of patients with corneal graft ulcer after keratoplasty. T test, x2 test and Logistic regression equation were used to analyze the risk factors of the occurrence of graft ulcer after keratoplasty. Results there were 892 males and 462 females with an average age of 44.89 卤18.45 years (0.25 卤86 years). 91 cases (91 eyes) were treated with graft ulcer, the mean age was 51.04 卤17.04 years (1 / 82 years). There were 1263 patients (1288 eyes) in non-graft ulcer group with an average age of 44.45 卤18.47 years (0.25 卤86 years). There was a significant difference in mean age between the two groups (P0.05). The ratio of men to women in both groups was the same, which was 1.9. Most of the graft ulcers occurred within one year after keratoplasty (59 cases, 64.8%), 15 cases (16.5%) complicated with anterior chamber pus, 73 cases (80.2%) infiltrated deep stroma, 4 cases (4.4%) developed corneal graft perforation. The shape of graft ulcer was round and round (54 cases, 59.3%), and most of them were not involved in the implantation bed. The ulcers could be located in the center of the graft (46 cases, 50.5%) or around the graft (45 cases, 49.5%). The long diameter of the graft ulcer in the peripheral part was generally 鈮，
本文编号：2454265
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