部分板层角膜移植治疗圆锥角膜多中心研究的初步报告

A primary mlticenter report of lamellar keratoplasty in treatment of keratoconus

目的观察板层角膜移植治疗不同阶段圆锥角膜的可行性及临床疗效。方法2001年1月至2003年12月对12例13眼不同发展阶段的圆锥角膜患者行部分板层角膜移植术(lamellarkeratoplasty,LKP)。病例筛选标准:(1)框架眼镜矫正视力<0.3,不能耐受角膜接触镜者;(2)圆锥角膜完成期,伴有智力障碍者,框架眼镜矫正视力<0.3;(3)一眼接受了穿透性角膜移植(penetratingkeratoplasty,PKP),术后曾发生排斥反应,另一眼框架眼镜矫正视力<0.3者。手术方法:植床大于锥底,剥离板层角膜接近后弹力层。供体植片直径根据患眼眼轴长度确定,眼轴≥24.5mm者,植床与植片等大,眼轴<24.5mm者,植片较植床大0.25mm。术后随访:术后对并发症、视力、角膜曲率、免疫排斥反应等进行观察。结果术后随访6～35月,平均19.1个月。5例、5眼对侧眼曾接受PKP。接受LKP12例、13眼,最佳矫正视力0.5者3眼,≥0.8者7眼,不合作2眼;角膜散光在2.5～5.5D之间,平均3.4D。PKP术后的5眼最佳矫正视力≤0.3者2眼,0.5者1眼,≥0.8者2眼;角膜散光在4.2～9.6D之间,平均5.8D。观察期内接受了PKP的5例对侧眼中3眼发生内皮型免疫排斥反应;所有行LKP的病例均未发生免疫排斥反应。结论LKP是治疗圆锥角膜的有效方法,特别适用于1眼已发生过免疫排斥反应。

Objective To evaluate the clinical results of lamellar keratoplasty (LKP) in treatment of keratoconus. Methods Twelve keratoconus patients (13 eyes) received LKP from 2001 to 2003.1. Admission criterions:(1)kerotoconus patients whose best corrected visual acuity (BCVA) were less than 0.3,could not tolerance the rigid gas permeable contact lens. (2) keraotconus patients with mental retard, one or two eyes BCVA were less than 0.3. (3)kerotoconus patients received penetrating keratoplasty ( PKP) in one eye and suffered from immune rejection, and the other (eye's) BCVA was less than 0.3. 2. Surgical technique: the bed was larger than the base of the taper. The cornea stroma was cut off until almost reach to the decement membrane. The donor size was lied on the the axial length (AXL) of the patients, a same-size donor was used for eyes with an AXL longer than 24.50 mm, whereas a 0.25mm oversized donor was used for eyes shorter than 24.49mm. 3. Postoperative follow up: postoperative follow up include uncorrected visual acuity (UCVA), BCVA, corneal curvature, complications, immune rejection.Results The mean follow up time was 19.1 months (rage from 6 to 35 months). BCVA was 0.5 in 3 patients, 0.8 or better in 7 eyes, noncooperation in 2 eyes, and the mean astigmatism was 3.4D (rage was from 2.5D to 5.5D) in patients who received LKP. 5 patients have received PKP, and 3 eyes suffered from endothelial immune rejection. There was no immune rejection episode was found in 12 patients (13 eyes) who received LKP. Conclusion LKP is an effective method in treatment of keratoconus, especially for patients with mental retard or patients having received PKP in one eye and suffered from endothelial immune rejection.