穿透性角膜移植术41例临床分析

Clinical analysis of penetrating keratoplasty

目的研究穿透性角膜移植术的病因构成、疗效及术后并发症。方法对近年来施行的41例（41眼）穿透性角膜移植术（PKP）患者的临床资料进行回顾性研究，记录病因、术前及术后视力，并观察术后植片透明度及并发症。结果术后第1天所有患眼植片基本透明，随访05～30年，植片透明34例，发生排斥反应后影响角膜透明度4例，单疱病毒性角膜炎复发致角膜云翳2例，角膜新生血管1例。术后第1天所有术眼视力好转，其中39眼较术前显著提高（P〈0．01）；随访至3年，术后视力〈005者3例，005～010者9例，0．2～05者25例，〉05者4例，较之术前均有显著改善（均P〈0．01）。术后发生并发症13例，其中继发性青光眼3例，排斥反应8例，原有疾病（单疱病毒性角膜炎）复发2例。结论穿透性角膜移植术是治疗严重角膜疾病的有效手段。

Objective To review the clinical data of penetrating keratoplasty （PKP）. Methods Forty one patients （41 eyes） underwent penetrating keratoplasty （PKP） in last three years and the patients were followed up for 0.5 -3y. The clinical data including causes, preoperative and postoperative visual acuity, clarity of grafts and complications were retrospectively reviewed. Results The causes for the 41 cases were herpes simplex keratitis in 21 cases （48.8%）, corneal scar in 5 （12.2%）, endothelial decompensation in 3 （7.3%）, corneal trauma in 2 （4.9%）, keratoconus in 3 （7.3%）, regraft in 2 （4.9%）, others in 5（ 12.2% ）. The follow-up showed that grafts were transparent in 34 cases, and in 39 cases the postoperative vision was significantly improved than preoprative vision （P〈0.01）. Of 13 cases with postoprative complications, 8 cases presented immune rejection, 3 complicated with secondary glaucoma and 2 had recurrent infection. Conclusion Penetrating keratoplasty is an effective means for severe keratic diseases.