236例儿童穿透性角膜移植术的临床分析

The indications and prognosis of penetrating keratoplasty in 236 children

目的探讨儿童穿透性角膜移植术（PKP）的病因、预后及影响预后的因素。方法选择1994年6月至2004年6月期间于山东省眼科研究所青岛眼科医院就诊的236例（257只眼）年龄小于14岁（3个月至14岁）、因各种原因角膜异常行PKP或PKP联合其他手术的患儿，共行266次PKP，随访时间6个月至9年5个月，平均为（21±13）个月。回顾性分析儿童PKP的病因特点、术后随访观察结果及影响儿童PKP预后的因素。结果儿童PKP的手术病因依次为先天性、发育性及与遗传有关的角膜疾病（99只眼，38．5％）、与角膜外伤有关的角膜疾病（82只眼，31．9％）、与角膜炎性反应有关的角膜疾病（76只眼，29．6％）。至最后一次随访，146只眼最佳矫正视力〉0．05，脱盲率为56．8％，其中与角膜炎性反应有关的角膜疾病占37．7％（55／146），9～14岁患儿占55．5％（81／146）。角膜植片总透明率为71．4％（190／266），单纯PKP角膜植片透明率为71．5％（138／193），行PKP联合其他手术的角膜植片透明率为71．2％（52／73），两者比较差异无统计学意义（x^2=0．002，P=0．965）；双眼手术的角膜植片透明率为50％（24／48），单眼手术的角膜透明率76．1％（166／218），两者之间比较差异有统计学意义（x^2=13．178，P=0．000）。有9例（12只眼）患儿接受21次重复PKP，角膜植片透明率为38．1％（8／21），与一次PKP术后角膜植片透明率（74．3％，182／245）间比较差异有统计学意义（x^2=12．413，P=0．000）。结论先天性、发育性及与遗传有关的角膜疾病是儿童行PKP的主要病因；手术预后受手术病因、发病年龄、是否联合玻璃体手术及是否双眼手术等多种因素的影响。（中华眼科杂志，2007，43：1005-1009）

Objective To evaluate indications, surgical details, factors affecting graft survival and determinants of visual acuity after penetrating keratoplasty （PKP） in children. Methods This was a retrospective analysis of 266 grafts of PKP performed in 257 eyes of 236 children, aged younger than 14 years between June 1994 and June 2004 in Shandong Eye Institute and Qingdao Eye Hospital. The patient characteristics, indications, and outcome with follow up 6 months to 9 years and 5 months,mean （21 ± 13） months were evaluated. Results On the basis of the corneal pathology, the indications of pediatric PKP were divided into three categories： related to congenital, hereditary and growth （99 eyes, 38.5% ）, related to trauma （82 eyes, 31.9% ） and related to keratitis （76 eyes, 29. 6% ）. At the last follow-up,the best corrected visual acuity of 146 eyes were better than 0. 05, 37.7% （55/146） of these eyes were related to keratitis, and 55.5% （81/146） aged more than 9 years; 190 （ 190/266, 71.4% ） of total grafts remained clear, in which, 52 （52/73, 71.2% ） grafts were related to additional surgical procedures remained clear, 24 （24/48, 50.0% ） were bilateral grafts and 8 （8/21, 38. 1%） were repeat grafts. There was no significant difference between only PKP and PKP additional surgical procedures （ x^2 = 0. 002, P = 0. 965 ）, and there was significant difference between the unilateral and bilateral grafts （ x^2= 13. 178, P = 0. 000 ）, between once and repeat PKP （x^2 = 12.413, P = 0. 000 ）. Conclusions The indications related to congenital, hereditary and growth are the main cause of pediatric PKP. The outcome is concerned with indications, ages onset, additional surgical procedures, bilateral grafts, and so on. Pediatric PKP is of benefit to children avoiding blindless caused by corneal opacity, especially combined with pre- and postoperative care. （Chin J Ophthalmol , 2007,43：1005-1009）