穿透性角膜移植术后并发性白内障临床研究
发布时间：2018-07-23 17:26
【摘要】：目的 观察并分析穿透性角膜移植术(PKP)术的原发病因与并发性白内障发生的时间以及PKP术后并发性白内障患者行囊外摘除术(ECCE)和超声乳化吸除术(PHACO)的疗效和安全性。 临床资料和方法 收集自2011年1月至2012年12月间在山东大学齐鲁医院行穿透性角膜移植术后并发性白内障摘除+人工晶体植入术并且定期随访的24例患者的临床资料,并进行回顾性分析。 PKP术后并发性白内障患者24例,分为ECCE禾PHACO两组,行相应的术前检查和准备后分别行囊外摘除和超声乳化吸除术+人工晶体植入术。定期随访,记录并对比分析两组患者术后视力、角膜内皮细胞计数和角膜散光情况。 结果 PKP病因与并发性白内障发生的时间：感染性角膜病变13例(54.17%),其中PKP术后并发性白内障发生时间为1年以内的11例(84.62%),1年以上的2例(15.38%)；外伤所致角膜白斑5例(20.83%),其中PKP术后并发性白内障发生时间为1年以内的3例(60%),1年以上的2例(40%)；角膜移植排斥反应4例(16.67%),其中PKP术后并发性白内障发生时间为1年以内的3例(75%),1年以上的1例(25%)；角膜变性或营养不良、大泡性角膜病变各1例(4.17%),并发性白内障均发生于PKP术后1年以内。 ECCE组和超声乳化组的疗效和安全可行性对比：ECCE和超声乳化吸除术两组24例术前和术后3个月最佳矫正视力存在统计学差异,术后3个月最佳矫正视力大等于0.4者所占比例分别为ECCE组80%和超声乳化组78.57%,经统计学检验无差异。两组术后3个月角膜内皮细胞丢失率分别为超声乳化组(10.01±2.8)%和ECCE组(7.8+2.4)%,两组之间存在统计学差异。两组术后3个月角膜散光度数分别为超声乳化组(4.17±2.10)D和ECCE组(5.17±2.19)D,经统计学检验存在差异。 结论 PKP术后并发性白内障患者中最常见的PKP原发病因是感染性角膜炎,术后并发性白内障多发生于PKP术后1年以内,各种PKP病因对PKP术后并发性白内障发生时间无明显影响。 PKP术后并发性白内障患者行ECCE和白内障超声乳化吸除术的疗效均十分显著,安全性均令人满意。其中超声乳化手术对角膜内皮的损伤要大于囊外摘除术,但术后散光较囊外摘除术小。
[Abstract]:Objective to observe and analyze the primary cause and time of complicated cataract in penetrating keratoplasty (PKP) and the efficacy and safety of extracapsular extraction (ECCE) and phacoemulsification (PHACO) in patients with cataract after PKP. Methods from January 2011 to December 2012, 24 patients underwent cataract extraction and intraocular lens implantation after penetrating keratoplasty in Qilu Hospital, Shandong University, and were followed up regularly. 24 patients with cataract after PKP were divided into two groups: ECCE and PHACO. The patients underwent extracapsular extirpation and phacoemulsification intraocular lens implantation respectively. The postoperative visual acuity, corneal endothelial cell count and corneal astigmatism were recorded and compared between the two groups. Results the etiology of PKP and the time of complicated cataract: 13 cases (54.17%) were infective keratopathy, of which 11 cases (84.62%) were complicated with cataract within one year after PKP, and 2 cases (15.38%) were over one year. There were 5 cases (20.83%) of corneal leukoplakia caused by trauma, of which 3 cases (60%) were complicated with cataract within one year after PKP, and 2 cases (40%) more than one year. Corneal allograft rejection was found in 4 cases (16.67%), including 3 cases (75%) with cataract after PKP, 1 case (25%) with corneal degeneration or malnutrition, 1 case (25%) with corneal allograft rejection, 3 cases (75%) with cataract after PKP, and 1 case (25%) with corneal allograft rejection. One case (4.17%) of bullous keratopathy occurred within 1 year after PKP. The curative effect and safety feasibility of ECCE group and phacoemulsification group were compared with 24 cases of preoperation and operation in two groups: Ecce and phacoemulsification. The best corrected visual acuity (BCVA) was statistically different after 3 months. Three months after operation, the proportion of the patients with the best corrected visual acuity equal to 0.4 was 80% in the ECCE group and 78.57 in the phacoemulsification group. There was no statistical difference between the two groups. The loss rate of corneal endothelial cells was (10.01 卤2.8)% in phacoemulsification group and (7.82.4)% in ECCE group at 3 months after operation, and there was significant difference between the two groups. The corneal astigmatism was (4.17 卤2.10) D in phacoemulsification group and (5.17 卤2.19) D in ECCE group 3 months after operation. Conclusion Infectious keratitis is the most common cause of PKP in patients with cataract after PKP. The most common cause of complicated cataract after PKP is less than 1 year after PKP. The effect of ECCE and phacoemulsification on the occurrence time of cataract after PKP was significant and the safety was satisfactory. Phacoemulsification caused more damage to corneal endothelium than extracapsular extirpation, but astigmatism was smaller than extracapsular extirpation.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R779.65
本文编号：2140115
[Abstract]:Objective to observe and analyze the primary cause and time of complicated cataract in penetrating keratoplasty (PKP) and the efficacy and safety of extracapsular extraction (ECCE) and phacoemulsification (PHACO) in patients with cataract after PKP. Methods from January 2011 to December 2012, 24 patients underwent cataract extraction and intraocular lens implantation after penetrating keratoplasty in Qilu Hospital, Shandong University, and were followed up regularly. 24 patients with cataract after PKP were divided into two groups: ECCE and PHACO. The patients underwent extracapsular extirpation and phacoemulsification intraocular lens implantation respectively. The postoperative visual acuity, corneal endothelial cell count and corneal astigmatism were recorded and compared between the two groups. Results the etiology of PKP and the time of complicated cataract: 13 cases (54.17%) were infective keratopathy, of which 11 cases (84.62%) were complicated with cataract within one year after PKP, and 2 cases (15.38%) were over one year. There were 5 cases (20.83%) of corneal leukoplakia caused by trauma, of which 3 cases (60%) were complicated with cataract within one year after PKP, and 2 cases (40%) more than one year. Corneal allograft rejection was found in 4 cases (16.67%), including 3 cases (75%) with cataract after PKP, 1 case (25%) with corneal degeneration or malnutrition, 1 case (25%) with corneal allograft rejection, 3 cases (75%) with cataract after PKP, and 1 case (25%) with corneal allograft rejection. One case (4.17%) of bullous keratopathy occurred within 1 year after PKP. The curative effect and safety feasibility of ECCE group and phacoemulsification group were compared with 24 cases of preoperation and operation in two groups: Ecce and phacoemulsification. The best corrected visual acuity (BCVA) was statistically different after 3 months. Three months after operation, the proportion of the patients with the best corrected visual acuity equal to 0.4 was 80% in the ECCE group and 78.57 in the phacoemulsification group. There was no statistical difference between the two groups. The loss rate of corneal endothelial cells was (10.01 卤2.8)% in phacoemulsification group and (7.82.4)% in ECCE group at 3 months after operation, and there was significant difference between the two groups. The corneal astigmatism was (4.17 卤2.10) D in phacoemulsification group and (5.17 卤2.19) D in ECCE group 3 months after operation. Conclusion Infectious keratitis is the most common cause of PKP in patients with cataract after PKP. The most common cause of complicated cataract after PKP is less than 1 year after PKP. The effect of ECCE and phacoemulsification on the occurrence time of cataract after PKP was significant and the safety was satisfactory. Phacoemulsification caused more damage to corneal endothelium than extracapsular extirpation, but astigmatism was smaller than extracapsular extirpation.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R779.65
【参考文献】
相关期刊论文 前3条
1 刘伟;何书喜;;白内障术后散光的研究进展[J];国际眼科杂志;2008年02期
2 孙堂胜;;糖尿病患者白内障术后的急性前房反应[J];国际眼科杂志;2009年01期
3 刘惠娟;曾强;;白内障冷超声乳化手术临床疗效分析[J];中国全科医学;2010年15期
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