小植片角膜移植治疗偏心性角膜穿孔的疗效评价

Evaluation of penetrating keratoplasty with small grafts for the treatment of eccentric corneal perforation

目的评价甘油保存角膜的小植片穿透性角膜移植治疗偏心性角膜穿孔的临床疗效。方法回顾性分析2007年11月1日至2010年4月30日期间因偏心性角膜穿孔在温州眼视光医院应用甘油保存角膜行小植片穿透性角膜移植的连续病例12例（12只眼）。随访观察视力变化、术后角膜地形图和角膜内皮细胞数，记录并发症的发生和转归。结果所有患眼均获得临床治愈，眼球完整性得以保持。末次随访裂隙灯检查示3例（25％）植片透明，其它患者的植片轻度混浊。术后裸眼视力较术前裸眼视力有明显提高（P=0．002），术后最佳矫正视力大于0．8者占50％。术后角膜散光平均为（－2．12±1．27）D。末次随访角膜内皮细胞数量平均为（2570±495）cells／mm^2。所有患者均未发现免疫排斥反应、继发性青光眼、并发性白内障等并发症。结论应用甘油保存角膜的小植片穿透性角膜移植能安全有效地治疗偏心性角膜穿孔，提高视力，避免术后并发症的发生。甘油角膜满足了角膜穿孔急诊手术的需要，也缓解了新鲜角膜缺乏的现状。

Objective To evaluate the clinical effect of small-diameter Penetrating Keratoplasty （PK） with glycerin-cryopreserved graft for the treatment of eccentric comeal perforation. Methods Retrospective analysis was performed on 12 consecutive cases （12 eyes） of eccentric corneal perforations which received smalldiameter PKs with glycerin-cryopreserved grafts from November 1st, 2007 to April 30th, 2009 at Wenzhou Eye Hospital. Pre- and postoperative visual acuity, clarity of graft, postoperative corneal topographic result, postoperative endothelial cell density and complications were analyzed. Results All of the 12 cases achieved global integrity. Slit-lamp examination showed transparent grafts on 3 eyes （25%）, while cloudy grains were showed on the other eyes. A significant improvement in the uncorrected distance visual acuity （UDVA） were noted in all cases （P =0.002）. Corrected distance visual acuity （CDVA） more than 0.8 were noted in 50% of the cases. A mean value of keratometric astigmatism of （-2.12± 1.27） diopters were detected in our cases. No immune rejection, secondary glaucoma and cataract were developed in all cases after surgery. The average corneal endothelial cell density was （2570± 495） cells per square millimeter. Conclusions The small-diameter PK with glycerin-cryopreserved graft for the treatment of eccentric comeal perforation is safe and efficient, which may be considered as an altemative to the fresh graft.