全角膜移植术后青光眼的预防和治疗

Prevention and treatment of the glaucoma after total keratoplasty

目的探讨全角膜移植手术方式和青光眼房水排出装置（glaucomadrainagedevices，GDDs）植入对全角膜移植术后青光眼的预防和治疗效果。方法回顾分析全角膜移植病人50例50眼。手术方式包括带周边板层巩膜环的叠加缝合的全角膜移植和边对边缝合的全角膜移植，比较这两种手术方式对术后青光眼的预防作用。同时，观察GDDs植入对全角膜移植术后青光眼的疗效。结果全角膜受损的50眼中48眼（96%）保全眼球，角膜植片透明率42．9％。术后视力较术前明显改善（P=0．001），术后2眼视力下降、20眼不变、28眼提高。23眼0．02以上，其中3眼超过0．3。引起术后青光眼的危险因素有术前角膜穿孔（RR=192）、边对边缝合的全角膜移植（RR=3．97）、术后房角广泛闭合（≥2／3，RR=34）。带周边板层巩膜环的叠加缝合的全角膜移植与边对边缝合的全角膜移植相比，明显降低术后青光眼发生率（P=0．05）。21眼（42％）确诊为青光眼，GDDs植入的16眼中，12眼（75％）眼压（IOP）得到控制。结论带周边板层巩膜环的叠加缝合的全角膜移植有降低全角膜移植术后青光眼发生率的作用。GDDs植入是治疗全角膜移植术后青光眼的有效手段之一。

Objective To investigate the efficacy of the surgical techniques of total keratoplasty and glaucoma drainage devices（GDDs） in preventing and treating the glaucoma after the keratoplasty. Methods 50 eyes with total cornea damaged were treated with total keratoplasty without or with peripheral sclera （sclerokeratoplaty） and the preventing efficacy of the two surgical techniques for secondary glaucoma were compared. And the efficacy of GDDs for the glaucoma was assessed. Results 48 of 50 （96%） eyes with total cornea damaged were reserved and 42.9% transplanted cornea were transparent. The visual acuity （VA） was significantly improved after surgery （P=0.001）. The VA after the surgery declined in 2 eyes, no changed in 20 eyes, improved in 28 eyes. The VA of 23 eyes was better than 0.02 and 3 eyes better than 0.3 among them. The risk factors for the glaucoma after the keratoplasty included perforated cornea （RR=192）, total keratoplasty without sclera （RR=3.97）, anterior chamber angle closed over 2/3 （RR=34）. Secondary glaucoma was significantly associated with total keratoplasty as compared with sclerokeratoplasty（P=0.05）.21 （42%） eyes were di- agnosed as secondary glaucoma. 16 eyes of them were treated with GDDs and the IOP of 12（75%） eyes was controlled. Conclusions Sclerokeratoplasty can reduce the incidemece of secondary glaucoma after total keratoplasty and GDDs implantation is an effective way for the glaucoma.