自体角膜瓣翻转联合板层角膜移植治疗边缘性角膜穿孔

Lamellar keratoplasty combined with lamellar corneal autograft reversion in treatment paracentral corneal perforation

目的 探讨用自体角膜瓣翻转封闭角膜穿孔重建前房 ,并联合板层角膜移植治疗边缘性角膜溃疡穿孔的临床疗效。方法 对 11例 11眼不同病因引起的边缘性角膜溃疡穿孔患者行自体角膜瓣翻转封闭角膜穿孔口重建前房后 ,再行板层角膜移植术 (lamellarkeratoplasty ,LK )治疗 ,术后对并发症如层间积液、虹膜前粘连、继发青光眼以及视力和免疫排斥反应等进行观察。结果 平均随访 12个月 (范围 6～ 18) ,所有患者植片透明 ,未发现层间积液 ,前房深度正常 ,无虹膜前粘连和继发青光眼。大于 6个月随访 ,裸眼视力较术前平均提高 4行 ,最佳矫正视力提高 7行 ,平均散光4 3D。 1例患者术后 8个月出现基质型免疫排斥反应 ,抗排斥治疗后排斥反应控制。结论 自体角膜瓣翻转联合LK是治疗边缘性角膜穿孔的有效方法。

Objective To study the clinical result of combined lamellar corneal autograft reversion with lamellar keratoplasty in the treatment of paracentral corneal perforation.Methods Combined lamellar corneal autograft reversion with lamellar keratoplasty were preformed in eleven eyes(eleven patients)with different etiology.Postoperative evaluation included double chamber,intraocular pressure,anterior chamber depth,vision and immune rejection and so on.Results The average follow up time was 12(from 6 to 18)months.All the grafts are clear and the intraocular pressure are normal,no double chamber and iris synechia.The average uncorrected vision was elevated 4 lines and the best corrected vision was elevated 7 lines postoperatively,the average astigmatism was 4 3 D.Graft rejection was occured in one eye and the graft became clear after supressimmunology treatment.Conclusions Combined lamellar corneal autograft reversion with lamellar keratoplasty is an effective method for treating paracentral corneal perforations.