深板层角膜移植修复瘢痕期圆锥角膜

中国组织研究  2013, Vol. 17  Issue (5): 872-877     DOI: 10.3969/j.issn.2095-4344.2013.05.017 组织移植 深板层角膜移植修复瘢痕期圆锥角膜 Deep lamellar keratoplasty for scarring stage keratoconus 全文: PDF (455 KB)   摘要  背景：深板层角膜移植治疗圆锥角膜可显著提高视力，且并发症少，排斥反应率低，但对于瘢痕期圆锥角膜仍以部分穿透性角膜移植为主。 目的：评价深板层角膜移植治疗瘢痕期圆锥角膜的临床疗效。 ：58例Ⅲ期、Ⅳ期有角膜瘢痕患者分为角膜浅基质层有角膜瘢痕形成患者37例(浅瘢痕组)，角膜深基质层或全层有角膜瘢痕形成患者21例(深瘢痕组)。58例患者行深板层角膜移植，移植后随访12个月，比较移植前后视力变化。 结果与结论：所有患者角膜移植后裸眼视力与移植前比较均有明显提高。58只眼角膜植片均透明，其中1只眼角膜移植后2个月发生上皮型排斥反应，经药物治疗后恢复透明。深瘢痕组2例角膜移植后出现眩光，改做部分穿透性角膜移植。角膜移植后1年浅瘢痕组与深瘢痕组视力相比差异无显著性意义。提示深板层角膜移植治疗瘢痕期圆锥角膜可显著提高视力，且并发症少，排斥率低，是一种安全有效，长期疗效稳定的治疗方法，尤其对于大基底的圆锥角膜应作为首选。 关键词 ： 器官移植； 组织移植； 圆锥角膜； 瘢痕期； 深板层角膜移植； 角膜移植； 角膜瘢痕形成； 视力； 并发症； 白内障； 弱视； 青光眼； 其他基金； 器官移植图片文章；    Abstract： BACKGROUND: Deep lamellar keratoplasty for the treatment of keratoconus can improve the visual acuity significantly with less complications and low rejection rate, but the treatment of scarring stage keratoconus is mainly depends on the partial penetrating keratoplasty. OBJECTIVE: To evaluate the clinical efficacy of deep lamellar keratoplasty for the treatment of scarring stage keratoconus. METHODS: Fifty-eight patients with Ⅲ and Ⅳ scarring stage keratoconus were divided into two groups: patients with corneal scarring in the superficial corneal stroma (n=37, superficial scar group), patients with corneal scarring in the deep or whole corneal stroma (n=21, deep scar group). The 58 patients who had accepted deep lamellar keratoplasy were followed-up for 12 months and the changes of visual acuity before and after transplantation were compared. RESULTS AND CONCLUSION: Naked eye vision of all patients with deep lamellar keratoplasy was significantly improved compared with that before transplantation, and 58 corneal grafts were all transparent. Only one patient had epithelial rejection after 2 months postoperative, and the corneal graft became transparent after a drug treatment. Two patients with deep keratoconus scars experienced glare after the transplantation in deep scar group, and they were switched to partial penetrating keratoplasty treatment. There was no significant difference of visual acuity at 1 year after transplantation between superficial scar group and deep scar group. Deep lamellar corneal keratoplasty treatments can significantly improve the visual acuity of scarring stage keratoconus patients, while it is low in rejection rate with less complication. It is a safe, effective and feasible treatment method, especially for the treatment of large base keratoconus. Key words： organ transplantation; tissue transplantation; keratoconus; scar stage; deep lamellar transplantation; corneal transplantation;corneal scar formation; vision; complications; cataract; amblyopia; glaucoma; other grants-supported paper; photographs-containing paper of organ transplantation; 研究亮点: 1  ①深板层角膜移植术比部分穿透性角膜移植术具有较多优点，瘢痕期圆锥角膜行深板层角膜移植术效果如何？②对于基底大于等于8 mm瘢痕期圆锥角膜行部分穿透性角膜移植术植床如何选择？③对于基底大于等于8 mm瘢痕期圆锥角膜如何降低复发率及排斥率。 2  深板层角膜移植术治疗瘢痕期圆锥角膜可显著提高视力，排斥反应率低，术后恢复快、发生散光可能性小，对供体材料条件低，长期疗效稳定。 3  创新：深板层角膜移植术治疗圆锥角膜可显著提高视力，已得到大家公认，但对于瘢痕期圆锥角膜仍以部分穿透性角膜移植为主。该研究证实，对于瘢痕期圆锥角膜，深板层角膜移植术同样可以取得较好疗效。不足：本研究最少随访时间为26个月，随访时间偏短，另外，本研究仅观察了视力，应继续完善验光结果、眼压、视功能等指标。