深板层角膜移植术的临床应用及疗效

The Clinical Application and Curative Effect of Deep Anterior Lamellar Keratoplastv

目的临床总结应用深板层角膜移植术治疗圆锥角膜,深及角膜后板层的角膜斑翳,角膜溃疡,边缘性角膜变性以及格子样角膜营养不良的治疗效果,探讨深板层角膜移植术的临床应用适应症。方法总结2001年1月至2005年5月深圳市眼科医院住院行深板层角膜移植的患者共14例(18只眼),其中圆锥角膜2例,(病毒性)角膜斑翳2例,(细菌性)角膜斑翳2例,真菌性角膜溃疡2例,细菌性角膜溃疡3例,边缘性角膜变性3例(5只眼),格子样角膜营养不良2例(4只眼)。记录术后半年复诊视力及角膜曲率,并统计角膜移植并发症的发生。综合评估该手术的临床适应症。结果有2例发生排斥反应,其中1例为病毒性角膜斑翳,1例为真菌性角膜溃疡。有3例原发病复发,2例真菌性角膜溃疡,1例病毒性角膜溃疡。术后视力半年时查0.5以上的有13例,0.1以上的有2例,0.1以下的有3例。结论深板层角膜移植对治疗未及角膜后弹力层的病变有效,但在治疗感染性角膜溃疡及病毒性角膜斑翳的治疗效果差,易发生原发病的复发及角膜移植排斥反应。

Objective To review the curative effect of deep anterior lalnellar keratoplas in eating keratoconus, Corneal macula which affect the posterior lamellar, corneal ulcer, margin corneal degeneration and lattice corneal dystrophy. To discuss the indication of the operation. Methods we reviewed the 14 patients （18 eyes） who have trated by the deep anterior lamellar keratoplasty during Feb. 2001 to May. 2005 in Shenzhen eye hospital. The patients including 2 cases of keratoconus,2 cases of virulence corneal macula,2 cases of bacteria corneal macula,2 cases of fungal corneal ulcer,3 cases of bacteria comeal u lcer,3 cases （5 eyes） of margin comeal degeneration and 2 cases （4 eyes） of lattice corneal dystfophy. We record the visual acuity and comea curvature half year after the operation, and analasys the incidence of the complication of this operation. We generalize evaluated the c 1 inical indications of this operation. Results There were 2 cases have the reiechon, one is the virulence comeal macula and the other is one of the fungal conneal ulcer. There were 3 cases have the primary disease recmdescence,2 of fungal corneal ulcer and lof virulence comeal ulcer. There are 13 cases have the visual acuity better than 0.5, 2 cases better than 0.1 and 3 cases worse than 0.1 in half year after the operation. Conclusion Deep anterior 1 amellar keratoplasty is an effective way to treat the 1 esions which not affect the Descemet membrane. But have worse effect in treating the infection corneal u 1 cer and Virulence comeal macula, which easy to induce the recmdescence of the primary disease.