光学性全厚板层角膜移植术远期疗效的分析

A long-term evaluation for optic full thickness lamellar keratoplasty

目的观察光学性全厚板层角膜移植术（ｏｐｔｉｃｆｕｌ－ｔｈｉｋｎｅｓｓｌａｍｅｌａｒｋｅｒａｔｏｐｌａｓｔｙ，ＯＦＬＫ）与穿透性角膜移植术（ｐｅｎｅｔｒａｔｉｎｇｋｅｒａｔｏｐｌａｓｔｙ，ＰＫＰ）的远期疗效。方法对角膜内皮功能正常的浅、中层角膜病患者采用ＯＦＬＫ术２３例（２５只眼）和ＰＫＰ２１例（２３只眼）进行治疗，并对远期疗效（２～３年）患者进行分析。结果远期植片透明率ＯＦＬＫ术组为８４．０％、ＰＫＰ术组为６９．６％，脱盲率分别为８０．０％及７８．３％（Ｐ＞０．０５）；获０．３以上较好视力者分别为４０．０％及２１．７％（Ｐ＜０．０５）。结论ＯＦＬＫ术和ＰＫＰ术的远期光学效果相同，且具有板层角膜移植术安全、并发症少的优点。但其手术技巧和适应证有待进一步探讨。

Objective To investigate the long term optic effects of optic full thickness lamellar keratoplasty (OFLK) and penetrating keratoplasty (PKP) and compare their effects. Methods 44 cases (48 eyes) with stromal disorder with normal endothelial function were treated by OFLK (25 eyes) or PKP (23 eyes). The optic effect of OFLK group was compared with that of the PKP group, and the endothelial density in partial cases was observed. Results The rate of transparent graft of OFLK group was 84.0% , and that of PKP group was 69.6% at postoperative 2～3 years, the rate of escaping blindness being 80% and 78.3% respectively. The rate of obtaining more than 0.3 vision in OFLK group was 40.0%, and in PKP group was 21.7%. Postoperatively, the endothelial cell density tended to decrease with time in PKP group, but was relatively stable in OFLK group. Conclusion The results show that the optic effect of OFLK group is similar to that of PKP group, and the safety, less complications of OFLK group are the same as that of lamellar keratoplasty. It is considered that OFLK might have a bright future and the operative technique should be further studied.