穿透性角膜移植术后继发性青光眼的影响因素及治疗

Influencing factors and treatment of secondary glaucoma after penetrating keratoplasty

目的探讨穿透性角膜移植术(penetrating keratoplasty,PKP)后继发性青光眼的发病因素及防治措施。方法对120例(121眼)PKP患者的临床资料进行回顾性分析,探讨发生继发性青光眼患者其术前原发角膜病变的类型及术后主要临床表现,同时观察根据不同病因给予药物或手术治疗后的效果。结果 121眼中发生继发性青光眼者25眼,总发生率为20.66%;发生率较高的有角膜溃疡、排斥再移植、大泡性角膜病变,而单纯性角膜白斑、圆锥角膜、角膜营养不良或变性的发生率相对较低。术后引起继发性青光眼发生的相关因素早期主要由于黏弹剂滞留,严重眼前段炎症,术后发生虹膜前后粘连;晚期主要原因为角膜内皮失代偿,术后使用糖皮质激素未作定期随访,发生免疫排斥反应等。所有患者经分析病因后给予药物或联合手术治疗眼压均得到有效控制。结论 PKP术后继发性青光眼的发生率与术前角膜病变的类型有相关性,临床准确分析病因、给予对应处理可有效控制眼压。

Objective To investigate the risk factors,precaution and treatment of secondary glaucoma after penetrating keratoplasty（PKP）.Methods The patients with secondary glaucoma after PKP（120 cases,121 eyes） were retrospectively analyzed.Type of preoperative primary keratoplasty and the main postoperative clinical manifestations were investigated.And then the effect was observed under the different treatment.Results For 121 eyes,secondary glaucoma occurred in 25 eyes,the total incidence rate was 20.66%.Higher incidence was found in eyes with corneal ulcers,re-transplant rejection,bullous keratopathy,followed by adherent leukoma,penetrating injury,chemical injury,the incidence rate of simple leucoma,keratoconus,corneal dystrophy and degeneration was relatively lower.The relative factors of postoperative secondary glaucoma mainly due to viscoelastic agent retention,severe anterior segment inflammation,postoperative adhesions around the iris;And the main reasons for the late was corneal decompensation,use of corticosteroids did not make regular follow-up,immune rejection,etc.All patients were taken drug treatment or surgical therapy,and intraocular pressure had been effectively controlled.Conclusions The incidence of secondary glaucoma after PKP relates with the primary corneal disease preoperatively.Accurate analysis of clinical cause and corresponding treatment can effectively control the intraocular pressure.