自体转位穿透性角膜移植的疗效评价

Evaluation of rotational autokeratoplasty

目的 :评价自体转位角膜移植 (rotationalautokeratoplasty ,RAP)的疗效。方法 :对 2 1例 (2 1只眼 )角膜白斑的患者实施RAP ,观察手术前后视力和植片的变化 ,并对手术和术后并发症进行探讨。结果 :平均随访时间 13 1个月 ,8例 (8只眼 )仅实施RAP ,其余 13例 (13只眼 )除实施RAP外还联合白内障摘出、人工晶状体植入、瞳孔成形以及玻璃体切割术。术后视力比术前明显提高 ,所有植片中央区透明 ,未见新生血管侵入植片。 1例发生吻合口渗漏 ,重新缝合后愈合良好。 5例出现高眼压 ,其中 3例用抗青光眼药物眼压控制正常 ,2例眼压自行恢复正常。结论 :RAP术后不发生排斥反应 ,增视效果较明显 ,对于角膜中央白斑和某些高危病例是一种有效的治疗方法。

Objective:To evaluate the effect of the rotational autokeratoplasty(RAP)in treating corneal leucoma.Methods: RAP was performed in 21 patients( 21 eyes)for corneal leucoma ,and the preoperative and postoperative visual acuities and changes of corneal grafts were compared.The surgical technique and postoperative complications were discussed. Results: The mean follow-up was 13.1 months.8 patients underwent only RAP ,while additional procedures including cataract extraction with intraocular lens implantation,pupilloplasty,anterior vitrectomy were performed in remaining 13 patients.The visual acuity improved,the central zone of the grafts were clear and no vascularization of grafts occured in all cases postoperatively.Wound dehiscence occurred in 1 patient,and resuturing was performed with a good healing.High postoperative intraocular pressure occurred in 5 patients,of whom 3 patients necessitated the use of antiglaucomatous drugs for its control,while in 2 patients the intraocular pressure became normal gradually without medications.Conclusions: There is no rejection of RAP and its optical result is generally good,so it is a reliable and useful surgery for treatment of small central corneal scar and some high-risk cases.