白内障合并角膜病的手术方式探讨

Surgical method for keratopathy associated with cataract.

目的探讨白内障合并角膜病者的最佳手术治疗方式。方法对36例（36眼）白内障与角膜病同时存在并需行穿透性角膜移楫及白内障摘出术的患者：Ⅰ组11例角膜白斑或溃疡、穿孔，病变区直径≤5mm，采用先白内障囊外摘出及人工晶状体植入术，半年后再行穿透性角膜移植术。Ⅱ组15例角膜的病变区直径〉5mm采用穿透性角膜移植与白内障摘出及人工晶状体植入联合手术（简称三联术）。Ⅲ组10例行穿透性角膜移植，1年后再行白内障囊外摘出及人工晶状体植入术。随访脱察时间6～20个月，结果33例（91．67％）术后裸眼视力比术前有提高，植片成活率Ⅰ、Ⅱ、Ⅲ组分别占100．00％、86．67％和90．00％。最好矫正视力达0．8。Ⅰ、Ⅱ组患者术后屈光度差异大，平均球镜值（4．75±3．15）D，平均散光度（2．89±1．75）D，Ⅱ、Ⅲ组出现角膜内皮失代偿共3例。结论依据角膜病变情况，采用分次手术或三联术都能很好恢复视功能，分次手术有更高的安全性和治疗效果。

Objective To study the best Surgical method for keratopathy associated with cataract. Methods Thirty-six cases of keratopathy associated with cataract were treated with three surgical methods including combined procedure （ECCE ＋ IOL） followed by PKP a half year later in 11 eyes （ group Ⅰ ） , triple procedures （PKP＋ECCE ＋ IOL） in 15 eyes （group Ⅱ ）, and PKP followed by （ECCE ＋IOL） one year later in 10eyes （group Ⅲ）. All patients were followed up for 6 months to 20 months after surgery. The ratio of transparent grafts and surgical complications were recorded. Results After surgery, thirty three eyes of 33 patients grafts remained clear The uncorrected visual acuity improved 0.1 0.6, the best corrected vision was 0.8, Graft survival in three groups were 100% , 86.7% and90% respectively. Postoperative refractive error in group Ⅰ ,Ⅱ was prominent, and The average spherical refraction（4.75 ± 3.15 ） D, the average cylinder refraction （2.89 ± 1.75 ） D, Postoperative decompensation of comealendothelium in group Ⅱ. Ⅲ was prominent. Conclusions Adoption two-stepprocedures or triple procedures can all the very good instauration see the function, and divide the time to surgical operation contain higher safety with cure result.