深板层角膜移植术中后弹力膜穿孔特点临床处理及预后

发布时间：2018-03-02 13:37

本文选题：深板层角膜移植　切入点：后弹力膜穿孔　出处：《浙江大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：对深板层角膜移植术中后弹力膜穿孔特征做分类,评估不同穿孔的处理方法及其对术后双前房、术后视力、角膜内皮细胞数的影响。研究设计：回顾性研究数据和方法：分析于2011年6月至2013年2月在我院行全植床深板层角膜移植手术的病例,共184眼。术中发生后弹力膜穿孔的病例将其纳入本研究中共25眼。观察术中后弹力膜穿孔,依其穿孔特点分为,针尖型、裂隙型和张口型。评估各型穿孔术后前房内注气对术后双前房的影响,术后前房内注气对角膜内皮细胞数的影响,穿孔后行前房内注气的并发症,比较术前术后最佳矫正视力。结果：184眼于我院行深板层角膜移植术,术中发生后弹力膜穿孔病例纳入本研究中共25眼(13.5%),平均年龄37.5±16.6岁,男女比例15：10,术眼左右眼比例13：12。针尖型10例(40%),前房内少量注气的双前房持续时间为6(天),未行前房内注气的双前房持续时间为7.33±0.28(天),(p=0.07)。前房注气内皮细胞丢失率为31.15%+22.41%,前房未注气内皮细胞丢失率为24.90%±13.38%,(p=0.62)术前最佳矫正视力LogMAR1.28±0.63,术后末次随访最佳矫正视力LogMAR0.51±0.56,(p=0.62)。裂隙型9例(36%),前房内中量注气的双前房持续时间为14.5±2.08(天),未行前房内注气的双前房持续时间为24.0±1.44(天),(p=0.005)。注气后内皮细胞丢失率37.56%士15.01%,前房未注气内皮细胞丢失率为37.56%±15.01%,(p=0.038)。术前最佳矫正视力LogMAR1.50±0.78,术后末次随访最佳矫正视力LogMAR0.54±0.47,(p=0.008).张口型6例(24%),中量注气双前房持续时间为34.6士12.58(天),大量注气双前房持续时间为13.3士4.16(天),(p=0.049)。注气后内皮细胞丢失率50.35%±16.66%。术前最佳矫正视力LogMAR1.11±0.72,术后末次随访最佳矫正视力LogMAR0.96±0.70,(p=0.45). 结论：针尖型穿孔,往往不影响手术的进行,术后可不需特别处理,术后双前房约一周时间即可自行贴回。裂隙型后弹力膜穿孔,前房内注气可缩短术后双前房持续时间。张口型穿孔,术后行前房内注中大量空气有助于使后弹力膜贴合。但注气量的把握还需摸索。前房内大量注气,造成角膜内皮细胞损伤、术后一过性青光眼、瞳孔中等散大固定、虹膜萎缩。
[Abstract]:Aim: to classify the characteristics of perforation of elastic membrane in deep lamellar keratoplasty and to evaluate the treatment of different perforation and its influence on the visual acuity and the number of corneal endothelial cells. Research Design: a retrospective study. Data and methods: a total bed deep lamellar keratoplasty was performed in our hospital from June 2011 to February 2013. A total of 184 eyes were included in this study in 25 eyes with posterior elastic membrane perforation. The perforation of posterior elastic membrane was observed and divided into needle-tip type according to the characteristics of perforation. To evaluate the effect of gas injection in anterior chamber after operation on the number of corneal endothelial cells and the complications of gas injection in anterior chamber after perforation, and to compare the best corrected visual acuity before and after operation. Results Twenty four eyes underwent deep lamellar keratoplasty in our hospital. 25 eyes with posterior perforation of elastic membrane were included in this study. The average age was 37.5 卤16.6 years. The ratio of male to female was 15: 10, the ratio of eyes to eyes was 13: 12. 10 cases of needle type were divided into 40 cases. The duration of double anterior chamber with a small amount of gas injection in the anterior chamber was 6. The duration of the double anterior chamber without gas injection in the anterior chamber was 7.33 卤0.28. The loss rate of endothelial cells in the anterior chamber was 31.15%. 22.41 the rate of loss of endothelial cells without gas injection in anterior chamber was 24.90% 卤13.38 and 24.90% 卤13.38, respectively. The best corrected visual acuity (LogMAR1.28 卤0.63) before operation was 0.63, and the best corrected visual acuity (LogMAR0.51 卤0.56) in the last follow-up after operation was 0.62%. 9 cases of fissure type were divided into 36 cases and the duration of gas injection in anterior chamber was 14.5 卤2.08. The duration of double anterior chamber was 24.0 卤1.44. The rate of endothelial cell loss after gas injection was 37.56% + 15.01 and 37.56% 卤15.01 respectively. The preoperative best corrected visual acuity (LogMAR1.50) was 0.78, and the last follow-up was LogMAR0.54 卤0.47p 0.008. The duration of double anterior chamber was 34.6 卤12.58 (tianzao) and that of massive gas injection was 13.3 卤4.16. The loss rate of endothelial cells was 50.35% 卤16.660.The preoperative best corrected visual acuity (LogMAR1.11 卤0.72) and the last follow-up after operation were LogMAR0.96 卤0.70p0.45g. Conclusion: the needle-tip perforation often does not affect the operation, and can be treated without special treatment, and the double anterior chamber can be self-affixed in about one week after the operation, and the perforation of the fissure posterior elastic membrane can be carried out by itself. Air injection in anterior chamber can shorten the duration of double anterior chamber after operation. Open hole perforation, a large amount of air injection in the anterior chamber after operation helps to fit the posterior elastic membrane, but the quantity of gas injection still needs to be explored. A large amount of air injection in the anterior chamber, Cause corneal endothelial cell injury, postoperative transient glaucoma, pupil isomorphic fixation, iris atrophy.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R779.65

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