儿童穿透性角膜移植手术的临床观察

The Clinical Study on Penetrating Keratoplasty in Children

目的探讨儿童穿透性角膜移植手术的疗效。方法对在2003年4月～2004年9月于我院行穿透性角膜移植手术的儿童角膜盲连续病例29例(29眼)进行回顾性分析。结果术后23眼中12眼(52.17%)视力达0.05以上。29眼中19眼(65.52%)角膜保持透明,其中,圆锥角膜及先天性角膜内皮营养不良所有病例植片透明;6眼外伤性角膜瘢痕中5眼植片透明,1眼发生排斥;先天性角膜混浊6眼中4眼排斥;角膜溃疡3眼中2眼排斥;角膜带状变性2眼中1眼排斥;碱性化学伤2眼均排斥。29眼中8眼(27.6%)发生包括虹膜前后粘连、白内障、青光眼等并发症。结论不同原因造成的儿童角膜盲施行穿透性角膜移植手术的成功率不同。早期的手术干预、并发症的预防以及术后的强化弱视治疗是影响儿童穿透性角膜移植术疗效的重要因素。

Purpose To investigate the efficacy of penetrating keratoplosty in children. Methods A retrospective study was performed on 29 eyes of successive pediatric eases with corneal blindness that underwent penetrating keratoplasty. Results The visual acuity was more than 0.05 in 12 （52.17%） of 23 eyes. Grafts rernaines transparent in 19 （65.52%） of 29 eyes. The grafts of all eyes with keratoconus and congenital opacities were transparent. Clear grafts were achieved in 5 of 6 eyes with scars from trattma. Allograft rejeotion was occurred in 4 of 6 eyes with congenital corneal opacity, in 2 of 3 eyes with infective corneal ulcer, in 1 of 2 eyes band shaped corneal dystrophy and in 2 eyes of Alkali chemical injury. Complications of anterior/posterior iris synechia, cataract and glaucoma happened in 8 of 29 eyes （27.6%）. Conclusion The successful rates of pediatric keratoplasty were different due to different causes. Early surgical intervention, prevention of surgical complications and intensive amblyopia therapy may be important factors of penetrating keratoplasty in children.