两种保存的角膜材料治疗重度真菌性角膜溃疡

Two kinds of human corneas in the management of severe fungal keratitis caused by eye injuries

目的探讨利用两种保存方法的角膜供体材料行眼前段眼球壁重建术治疗重度真菌性角膜溃疡的临床效果。方法54例（54眼）重度真菌性角膜溃疡行眼前段眼球壁重建术。其中24例应用湿房保存的新鲜角膜植片（Ⅰ组），30例应用全眼球冷冻活性保存的角膜植片（Ⅱ组）。术后观察真菌复发、继发青光眼、植片排斥反应、术后视力及植片透明度等情况。结果54眼中有50眼（92．59％）成功地保存了眼球。但Ⅰ组、Ⅱ组各2眼（7．41％）真菌复发，最终摘除眼球。两组排斥反应发生率分别为77．3％和42.9％，差异有统计学意义（X^2=5．99，P〈0．05）。两组透明率分别为68．18％和53．57％，差异无统计学意义（X^2=1．09，P〉0．05）。最后一次随访的最佳矫正视力，Ⅰ组：〈0．1者5眼，0．1～0．28眼，≥0．3 9眼。Ⅱ组：〈0．1者7眼，0．1～0．211眼，≥0．3 10眼。两组间差异无统计学意义（X^2=0．14，P〉0．05）。表明两组远期视力无明显差异。结论利用湿房保存及全眼球冷冻活性方法保存的角膜材料行眼前段眼球壁重建术治疗重度真菌性角膜溃疡,使多数患眼得到挽救，并恢复了部分视功能，是一种有效的治疗方法。

Objective To investigate the resuhs of anterior segment reconstruction with two kinds of human corneas for the management of severe fungal keratitis. Methods 54 cases of severe fungal keratitis received anterior segment reconstruction with 24 fresh corneas preserved in moist chambers （ group one） and 30 cryopreserved corneas （group two）. The vision of sight, transpar- ent condition of the grafts and complications such as the reoccur- rence of fungal keratitis, secondary glaucoma and graft rejection were observed postoperatively. Results 50/54 cases of fungal keratitis were cured successfully. The reoccurrences of fungal keratitis happened in two cases of group one and group two respectively. The rejection rates in group one and group two were 77.3% and 42.9% respectively, the difference of which was significant （X^2 = 5.99, P〈0.05）. The transparent rates of the grafts in the two groups were 68.1% and 53.6% respectively. There was no difference between the two groups （X^2=1.09, P〈0.05）. The best corrected vision of final follow-up was as follows： In group one, 9 eyes ≥0.3, 8 eyes ≥0.1 and 5 eyes 〈0. 1. In group two, 10 eyes ≥ 0.3,11 eyes ≥0.1 and 7 eyes 〈0.1. There were no difference between the two groups （X^2 =0.14, P〈0. 05）. Conclusions Most of patients with fungal keratifis were raceessfully treated by anterior segment reconstruction with the fresh come, as preserved in moist chambers and the cryopreserved corneas which is effective management.