穿透性角膜移植排斥反应的临床分析

Clinical analysis of graft rejection in penetrating keratoplasty

目的 探讨导致穿透性角膜移植术后排斥反应的高危病种及危险因素。方法 对 86例 90眼穿透性角膜移植患者术后排斥反应发生率进行回顾性分析。结果 各病种排斥反应发生率不同 ,角膜溃疡为 4 2 86 % (9/2 1) ;粘连性角膜白斑为 39 13% (9/2 3) ;单纯性角膜白斑为 2 8 5 7%(8/2 8) ;角膜变性或营养不良为 11 11% (1/9) ;先天性角膜白斑为 10 0 0 0 % (1/1) ;圆锥角膜 5眼及大泡性角膜病变 3眼无排斥反应发生。术前角膜新生血管形成、虹膜前粘连、术前高眼压、术后高眼压、无晶状体状态、术式增多、大植片使排斥反应发生率增高。结论 高危病种有角膜溃疡、粘连性角膜白斑、单疱病毒性角膜炎及化学伤导致的单纯性角膜白斑。术前角膜新生血管形成 ,虹膜前粘连 ,术前、术后高眼压 ,无晶状体 ,多术式联合 ,大植片是排斥反应发生的危险因素。

Objective To evaluate risk factors and risk diseases for corneal graft rejection after penetrating keratoplasty (PK). Methods We retrospectively studied clinical results of PKs in terms of diagnoses,clinical manifestation,surgery,graft size,management of postoperative complications and rate of rejection.PKs were done on 90 eyes of 86 patients between 1996 and 2001. Results The rate of rejection in diseases:corneal ulcer 42 86%(9/21),adherent leucoma of cornea 39 13%(9/23),simple leucoma of cornea 28 57%(8/28),corneal degeneration and dystrophy 11 1%(1/9),congenital corneal leucoma 100%(1/1).There is no rejection in keratoconus and bullous keratopathy.Higher risks of graft rejection were associated with preoperative corneal vascularization,anterior synechiae of iris,preoperative and postoperative ocular hypertension,aphakia,more surgery,larger graft size. Conclusions Risk diseases include corneal ulcer,adherent leucoma of cornea,simple leucoma of cornea developed from herpes simplex keratitis or chemical burn.The risk factors for graft rejection were preoperative corneal vascularization,anterior synechiae of iris,preoperative and postoperative ocular hypertension,aphakia,more surgery and larger graft size.