深板层角膜移植术与穿透性角膜移植术治疗真菌性角膜溃疡的视功能疗效观察

The visual functional therapeutic effects of deep lameHar keratoplasty and penetrating keratoplasty for fungal corneal ulcer

目的探讨深板层角膜移植术（DLK）和穿透性角膜移植术（PK）两种术式治疗角膜溃疡患者的视功能疗效。方法回顾性病例研究。选择2004至2009年宁波鄞州人民医院眼科中心诊断明确的真菌性角膜溃疡患者64例（64只眼），分别行深板层角膜移植术（36例，36只眼）和穿透性角膜移植术（28例，28只眼），术后随访时间12—24个月。术前检查两组患者视力并验光，术后分析最佳矫正视力、角膜屈光状态、角膜内皮计数及并发症，采用四格表的x^2检验及两样本均数t检验。结果两组患者术后的视力均较术前提高，最佳矫正视力达1．0，DLK组32只眼术后视力在0．4以上，PK组19只眼术后视力在0．4以上，DLK组略高于PK组（x^2=4．304，P〈0．05）。DLK组术后散光小于PK组，差异有统计学意义（x^2=4．98，P〈0．05），两组平均散光均低于5．00D。DLK组排斥反应的发生较PK组低（x^2=34．17，P〈0．05）。结论深板层角膜移植术比穿透性角膜移植术治疗真菌性角膜溃疡的并发症少，能减少内皮型排斥反应的发生，且术后最佳矫正视力、角膜散光略优于穿透性角膜移植术。

Objective To investigate the visual functional therapeutic effects of deep lamellar keratoplasty （DLK） and penetrating keratoplasty （PK） on perforated fungal keratitis. Methods 64 patients （64 eyes） of fungal corneal uncler in Ophthalmology Center of Ningbo Yinzhou People Hospital from 2004 to 2009 were retrospected, of which undergo DLK （36 patients, 36 eyes） and PK （28 patients, 28 eyes）, and followed up by 12 to 24 months. Check two sets of patients＇ VA and refraction before operation, and analyze the best-corrected visual acuity （BCVA）, corneal refraction changes, corneal endothelium counting and complications, using X2 test and t-test. Results The BCVA after the operation of two sets are both improved, 32 eyes of DLK set were above 0. 4, 19 eyes of PK set were above 0. 4, of which the DKL set is a bit better than PK set （ X^2 = 4. 304, P 〉 O. 05 ）. The astigmatism of DLK set is smaller than the PK set after operation, and there is significant difference （ X^2 = 4. 98, P 〈 0.05 ）. The astigmatism of two sets on the average were all no more than 5.00 D. The reject reaction of keratoplasty of DLK is less than PK, there is obviously significant difference （ X^2 = 34. 17, P 〈 0. 05 ）. Conclusions There is less complications of DLK than PK for fungal corneal uncler. DLK can reduce the occurrence of reject reaction of endothelium type, and the BCVA, refraction of DLK after operation is similar to PK, the incidence rate of surgical operation failure is low.