穿透性角膜移植术治疗真菌性角膜溃疡穿孔

Penetrating keratoplasty for treatment of fungal keratitis with corneal perforation

目的探讨穿透性角膜移植术治疗真菌性角膜溃疡穿孔的临床疗效.方法对1994年至2003年在青岛眼科医院行穿透性角膜移植术的40例(40只眼)真菌性角膜溃疡穿孔患者进行随访,随访时间为6～24个月,观察术后视力变化和真菌复发、植片排斥、继发性青光眼、并发性白内障等并发症的发生情况.结果 40例患者中,39例(97.5%)成功地保存了眼球,38例(95.0%)不同程度地提高了视力.穿透性角膜移植术后,4例(10.0%)患者真菌复发,其中3例用药物治愈,1例因合并真菌性眼内炎用药物不能控制而摘除眼球;15例(37.5%)患者植片发生排斥,其中12例经抗排斥治疗植片转为透明,3例因药物治疗无效而行二次穿透性角膜移植术;3例(7.5%)患者植片发生溃疡,其中2例治愈,1例因合并角膜内皮功能失代偿而行二次穿透性角膜移植术;5例(12.5%)患者继发青光眼,眼压均得到成功控制;5例(12.5%)患者发生并发性白内障,其中3例行白内障摘除术.其余患者术后随访期间眼部情况稳定,植片保持透明.最终随访时,36例(90.0%)患者角膜植片透明.结论穿透性角膜移植术是治疗真菌性角膜溃疡穿孔的有效手术方式,是挽救眼球和视力的主要手段.(中华眼科杂志,2005,41:1009-1013)

Objective To evaluate the outcome of penetrating keratoplasty （PKP） for the treatment of fungal keratitis with corneal perforation. Methods 40 patients （40 eyes ） with corneal perforation secondary to fungal keratitis underwent PKP at Qingdao Eye Hospital from 1994 to 2003. The follow-up ranged from 6-24 months. The postoperative visual acuity and complications were documented. Results 39 （97.5%） patients preserved the eyeballs. The visual acuity improved in 38 （95. 0% ） eyes. Fungal infection recurred in 4 eyes, 3 of which were controlled with antifungal medication and 1 was enucleated because of the uncontrolled endophthalmitis. Graft rejection was observed in 15 （37. 5% ） eyes, 12 of which were cured with medication and 3 received secondary PKP. 3 （7.5%） eyes had graft ulceration, 2 of which were cured and the other one was regrafted because of severe endothelial cell loss. 5 （ 12. 5% ） eyes had secondary glaucoma, and the intraocular pressure was controlled medically and surgically. Complicated cataract occurred in 5 （12. 5% ） eyes, 3 of which underwent cataract extraction. Most complications were controlled successfully. At last follow-up, 36 （90. 0% ） grafts were clear. Conclusion PKP is an effective approach for preservation of eyeballs and restoration of visual function in patients eyes with fungal keratitis and corneal perforation.