全植床深板层角膜移植修复急性水肿后与未急性水肿圆锥角膜

发布时间：2018-04-17 20:28

  本文选题：深板层角膜移植 + 圆锥角膜　； 参考：《浙江大学》2014年博士论文

【摘要】：目的：评估全植床深板层角膜移植(FBDLK)修复急性水肿后与未急性水肿圆锥角膜的疗效,分析急性水肿后与未急性水肿圆锥角膜患者FBDLK术后各项指标的差异,评估角膜急性水肿对手术过程、术后并发症、视力、内皮细胞密度、角膜厚度的影响。 研究设计：回顾性研究 数据和方法：分析2011年4月至2014年3月于我院行FBDLK的圆锥角膜患者共108例131眼,纳入急性水肿圆锥角膜组的共19例19眼,随机选取未急性水肿圆锥角膜19例19眼组成对照组。观察急性水肿患者水肿消退过程,观察两组患者手术过程,比较分析两组患者的术后并发症,术后1天、1月、6月、12月随访时视力、内皮细胞密度、角膜厚度的变化情况。 结果：水肿组与对照组一般情况无显著性差异。水肿组患者100%存在疤痕,累及后弹力膜；对照组36.8%存在疤痕,为浅中层疤痕,未累及后弹力膜。急性水肿患者起病至发生急性水肿时间间隔5.21±±4.25年。急性水肿期角膜厚度1325.11±345.691μm,水肿消退后角膜厚度454.56±96.45μm,水肿消退时长107.89±25.72天,后弹力膜(DM)破口大小1.96±2.46mm2,后弹力膜与基质层距离321.1±240.58-m。水肿组与对照组术中穿孔率78.95%、0%,前房注气患者63.16%、0%,转穿透性角膜移植0%、0%,手术时长72.00±12.15分钟、64.744±14.48分钟。术后水肿组与对照组双前房10.53%、0%,眼压高5.26%、10.53%,继发性青光眼5.26%、0%,排斥反应0%、0%,植片失败0%、0%。两组患者术前、术后1天、术后1月、术后6月、术后12月裸眼视力分别为：水肿组0.075±0.084、0.086±0.087、0.198±0.115、0.275±0.215、0.396±0.189；对照组0.088±0.07、0.209±0.174、0.2694±0.171、0.299±0.140、0.361±0.178。各时间点最佳矫正视力分别为：水肿组0.1544±0.118、0.086±0.087、0.335±0.174、0.505±0207、0.563±0.199；对照组0.291±0.217、0.209±0.174、0.472±0.193、0.575±0.191、0.607±0.139。两组患者术前、术后1月、术后6月、术后12月角膜内皮细胞密度分别为：水肿组2397±454cells/mm2、1335±533cells/mm2.1434±432cells/mm2、1437±465cells/mm2;对照组2613±303cells/mm2,2276±286cells/mm2、2186±241cells/mm2、2198±234cells/mm2.两组患者术后1月、6月、12月内皮细胞丢失率分别为：水肿组45.2±29.1%、39.2±17.5%、35.3±34.5%；对照组11.44±12.0%、16.0±12.0%、15.0±9.1%。两组患者术前、术后1天、术后1月、术后6月、术后12月角膜厚度分别为：水肿组459.00±86.85μm.828.00±138.28μm,611.23±97.98μm、528.18±61.38μm、509.67±38.45μm;对照组416.07±63.07μm.618.92±65.39μm、546.38±47.85μm、497.94±38.85μm、487.73±24.70μm。 结论：圆锥角膜急性水肿患者FBDLK术后短期视力低于未急性水肿患者,远期视力与未急性水肿患者类似。急性水肿患者术后内皮细胞丢失较未急性水肿患者多,但内皮细胞数稳定,残留的内皮细胞仍可维持角膜透明。急性水肿患者短期内植片水肿较未急性水肿患者重,但远期角膜厚度与未急性水肿患者类似。考虑到角膜急性水肿对远期视力及植片水肿影响不大,且FBDLK术后内皮细胞数稳定,FBDLK手术应用于圆锥角膜急性水肿后的患者是可行并值得推广的。
[Abstract]:Objective: To evaluate the full bed deep lamellar keratoplasty (FBDLK) curative effect and no acute edema of keratoconus after repair of acute edema, differences with the indicators of FBDLK patients without acute edema of keratoconus after operation of acute edema after acute corneal edema on the assessment of surgical procedure, postoperative complications, visual acuity, endothelial cell density. The influence of corneal thickness.
Study design: a retrospective study
Data and methods: analysis of April 2011 to March 2014 in our hospital FBDLK patients with keratoconus were 108 cases 131 eyes included acute edema of keratoconus group a total of 19 eyes of 19 patients, randomly selected 19 cases of acute keratoconus without edema in 19 eyes as control group. Observation of edema in patients with acute edema subsided, observe two groups of patients during the operation, the comparative analysis of two groups of patients with postoperative complications, 1 days after the operation in January, June, December, follow-up visual acuity, endothelial cell density, the change of corneal thickness.
Results: the edema group and control group in general. No significant difference in 100% groups of patients with edema exist scar, involving the posterior elastic membrane; the control group 36.8% for superficial scar, scar, elastic membrane. After not involving the onset of acute edema to acute edema time interval was 5.21 + 4.25 years. Acute edema of corneal thickness 1325.11 + 345.691 m, edema of corneal thickness after 454.56 + 96.45 m, edema duration 107.89 + 25.72 days, Descemet's membrane (DM) tear size 1.96 + 2.46mm2, Descemet's membrane and matrix layer distance was 321.1 240.58-m. edema group and control group was 78.95%, the perforation rate 0%, anterior chamber gas injection in 63.16%, 0%, to penetrating keratoplasty in 0%, 0%, 72 + 12.15 minutes long during the operation, 64.744 + 14.48 minutes. The postoperative edema group and control group 0%, 10.53% double anterior chamber, intraocular pressure of 5.26%, 10.53%, 5.26% secondary glaucoma, 0%, 0%, 0%, rejection, graft failure 0%, two groups of 0%. patients before and after 1 days, after January, after June December, the postoperative uncorrected visual acuity were: edema group 0.075 + 0.084,0.086 + 0.087,0.198 + 0.115,0.275 + 0.215,0.396 + 0.189; control group 0.088 + 0.07,0.209 + 0.174,0.2694 + 0.171,0.299 + 0.140,0.361 + 0.178. at the time of the best corrected visual acuity respectively: edema group 0.1544 + 0.118,0.086 + 0.087,0.335 + 0.174,0.505 + 0207,0.563 + 0.199; control group 0.291 + 0.217,0.209 + 0.174,0.472 + 0.193,0.575 + 0.191,0.607 + 0.139. two groups of patients before and after surgery in January, after June, the density of corneal endothelial cells after December were edema group 2397 + 454cells/mm21335 + 533cells/mm2.1434 + 432cells/mm21437 + 465cells/mm2; the control group was 2613 + 303cells/mm22276 + 286cells/mm22186 + 241cells/mm22198 + 234cells/mm2. two group of patients after January, June, December, the rate of endothelial cell loss Respectively: edema group 45.2 + 29.1%, 39.2 + 17.5%, 35.3 + 34.5%; control group 11.44 + 12%, 16 + 12%, 15 + 9.1%. two groups of patients before operation, 1 days after surgery, after surgery in January, after June December, postoperative corneal thickness were: edema group 459 + 86.85 ^ m.828.00 138.28 + m, 611.23 + 97.98 m 528.18 + 61.38 m 509.67 + 38.45 m; control group 416.07 + 63.07 m.618.92 + 65.39 m 546.38 + 47.85 m 497.94 + 38.85 m 487.73 + 24.70 M.
Conclusion: keratoconus acute edema after FBDLK in patients with acute edema were not lower than short-term vision, long-term vision and acute edema were similar in patients with acute edema after surgery. Endothelial cell loss is not acute edema patients, but the number of endothelial cells, endothelial cells can maintain residual corneal transparency. Patients with acute edema short-term graft no edema of acute edema patients, but the long-term corneal thickness and no acute edema were similar. Considering the long-term vision and corneal edema on acute graft edema has little effect, and after FBDLK the number of endothelial cells, FBDLK surgery for keratoconus patients after acute edema is feasible and worthy of promotion.

【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R779.6

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