采用冰冻保存角膜行治疗性穿透性角膜移植术后再度光学性穿透性角膜移植疗效观察

发布时间：2018-07-10 05:14

本文选题：治疗性角膜移植 + 光学性角膜移植　；参考：《浙江大学》2010年硕士论文

【摘要】： 目的：回顾性总结采用冰冻保存角膜行治疗性穿透性角膜移植(Therapeautic penetrating keratoplasty, T-PKP)后再度行光学性穿透性角膜移植(Optical Penetrating keratoplasty, O-PKP)的临床疗效。资料与方法：回顾1998年10月至2008年10月在我院就诊,采用冰冻保存角膜行T-PKP,术后再次接受O-PKP治疗,且术后规律随访超过6个月的所有患者的病历资料,分析其术后植片存活状态,并发症,内皮细胞密度变化和术后视力转归等情况。结果：符合纳入标准的病例共44例(44眼),在O-PKP术后中位数随访时间为19个月(6-76个月)的过程中,14眼发生植片失代偿,植片生存率68.2%,透明植片估计生存均值49.8±5.0月。植片失代偿的危险因素中,O-PKP术后排斥反应的相对危险度为20.10(P=0.01),术后继发性青光眼的相对危险度为6.72(P=0.040.05),在统计学上均有相关性,但年龄、T-PKP术前是否发生角膜穿孔、T-PKP植片大小、O-PKP是否联合白内障手术、O-PKP术后是否再行眼内手术等因素在统计学上无相关性。T-PKP后继发性青光眼予药物及手术治疗后眼压仍高者15眼(34.1%),而O-PKP术后仅5眼(11.4%)发生继发性青光眼,两者比较有显著性差异(P0.05),上述15眼术前平均眼压38.3±9.0mmHg,经O-PKP粘连房角分离及眼前段重建,术后1月、6月、12月平均眼压降至17.7±8.9 mmHg、18.0±7.5 mmHg、17.1±6.5mmHg,较术前明显降低,两者比较在统计学上有高度显著性差异(P0.01)。O-PKP术后23眼(52.3%)发生一过性排斥反应,经药物治疗后均控制,但13眼最终发生植片失代偿。O-PKP术后17眼晶体尚透明,予保留,其中12眼(70.6%)术后出现并发性白内障,透明晶体估计生存均值为24.1±3.7月。O-PKP术后12月总体内皮细胞密度较术后1月下降25.2±35.6%(P0.01)。O-PKP术后1年中位数最佳矫正视力(best corrected visual acurity,BCVA)为0.4,末次随访中位数BCVA为0.15,其中19眼末次随访BCVA0.4。结论：采用冰冻保存的角膜行T-PKP,在治愈原发疾病并保全眼球后,再行O-PKP可获得理想的植片生存率,并发症少,视力恢复良好。再度O-PKP植片生存的危险因素为术后排斥反应和继发性青光眼。再度O-PKP对T-PKP术后的继发性青光眼有一定程度上的治疗作用。
[Abstract]:Objective: to summarize the clinical effect of optical penetrating keratoplasty (O-PKP) after Therapeautic penetrating keratoplasty (T-PKP). Materials and methods: from October 1998 to October 2008, all patients with frozen corneal preservation were treated with T-PKP and received O-PKP treatment again, and the patients were followed up regularly for more than 6 months. The survival status, complications, changes of endothelial cell density and postoperative visual acuity were analyzed. Results: 44 cases (44 eyes) met the inclusion criteria. The median follow-up time of O-PKP was 19 months (6-76 months). The graft decompensation occurred in 14 eyes, the survival rate was 68.2 and the mean survival of transparent graft was 49.8 卤5.0 months. Among the risk factors of graft decompensation, the relative risk of rejection was 20.10 (P0.01) for post-operative rejection and 6.72 (P0.040.05) for postoperative secondary glaucoma. However, there was no statistical correlation between the age of T-PKP and the size of T-PKP graft and the combination of O-PKP and intraocular surgery after cataract surgery. The pressure was still high in 15 eyes (34.1%), but only 5 eyes (11.4%) developed secondary glaucoma after O-PKP. There was significant difference between the two groups (P0.05). The mean intraocular pressure (IOP) of the 15 eyes was 38.3 卤9.0mmHg. after O-PKP conglutination angle separation and anterior segment reconstruction, the mean IOP decreased to 17.7 卤8.9 mmHg 18.0 卤7.5 mmHg 17.1 卤6.5 mmHg in 1 month, 6 months and 12 months after operation. There was a statistically significant difference (P0.01) .O-PKP in 23 eyes (52.3%) with transient rejection, which was controlled after drug therapy, but 17 eyes after graft decompensation (.O-PKP) were still transparent and preserved. Among them, 12 eyes (70.6%) developed complicated cataract after operation. The mean survival value of transparent lens was 24.1 卤3.7 months. The total endothelial cell density decreased by 25.2 卤35.6% (P0.01). O-PKP decreased by 25.2 卤35.6% (P0.01). The median corrected visual acuity (best corrected visual acurityBCVA) in one year after operation was 0.4, and the median BCVA at the last follow-up was 0.15. among them, 19 eyes were followed up at the last time. Conclusion: the frozen cornea were treated with T-PKP. After curing the primary diseases and preserving the eyeball, O-PKP could obtain the ideal survival rate of grafts, fewer complications and better visual acuity. The risk factors for survival of O-PKP graft were postoperative rejection and secondary glaucoma. Re-O-PKP has a certain therapeutic effect on secondary glaucoma after T-PKP.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.65

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