儿童穿透性角膜移植术并发症原因及防治原则

Analysis,prospect and treatment of causes of penetrating keratoplasty complications in children

目的探讨儿童穿透性角膜移植术（pentrating keratoplasty.PKP）并发症的发生原因及防治原则。方法对78例（80只眼）行PKP手术中发生并发症者进行并发症种类及原因分析。结果儿童PKP手术中出现并发症者30只眼,其中不同程度的植床血管出血9只眼（11.3%）,虹膜脱色素14只眼（17.5%）,虹膜损伤者6只眼（7.5%）,晶体玻璃体脱出者1只眼（1.3%）;术后并发症,其中角膜免疫排斥反应24只眼（30%）,植片感染7只眼（8.8%）,继发性青光眼6只眼（7.5%）,角膜植片哆开3只眼（3.8%）,原发病复发1只眼（1.3%）。结论术后角膜免疫排斥反应及植片感染、继发青光眼是儿童PKP手术的主要并发症;随着手术技术的日趋成熟及重视围手术期处理,各类手术并发症将明显减少;出现并发症后应积极采取有效的治疗措施。

Objective To analyze the causes of different complications of penetrating keratoplasty （PKP） in children and to investigate their principles of treatment and prevention. Methods The causes of d ifferen t co mplication s in 78 child ren （8 0 eyes） h av ing u nd erg on e PKP were analy zed. Results Intraoperatively,the common complications of PKP in children were various degree of hemorrhage arising from residual bed in 9 eyes （11.3%）,iris depigmenting in 14 eyes （17.5%）,iris damage in 6 eyes （7.5%）,vitreous and lens extrusion in 1 eyes （1.3%）. The common complications after the operation were graft rejection in 24 eyes （30%）,graft infection in 7 eyes （8.8%）,secondary glaucoma in 6 eyes （7.5%）,graft dehiscence in 3 eyes （3.8%） and relapses of underlying disease in 1 eye （1.3%）. Conclusions Graft rejection,graft infection and secondary glaucoma is the main complications after PKP in children. The different complications can be diminished following the advances in the techniques and perioperative management of the surgery. It should be properly managed once the complication has occurred,and good operative effects can be obtained.