增视性角膜移植术后角膜植片透明率及影响因素

Transparent rate of corneal graft and its influencing factors after optical penetrating keratoplasty

目的:探讨增视性角膜移植术后角膜植片的透明率及其影响因素。方法:回顾性病例研究。选择2004-01/2005-12于青岛眼科医院行增视性穿透性角膜移植术(optical penetrating keratoplasty,PKP)的患者97例105眼,包括圆锥角膜,角膜基质营养不良,外伤、感染等因素导致的角膜白斑,单纯疱疹病毒性角膜炎稳定期,角膜内皮细胞功能失代偿等。统计分析术前视力及术后最佳矫正视力、角膜植片透明情况、内皮细胞计数、是否排斥、植片混浊原因,采用R×C表及四格表的χ2检验。结果:增视性PKP术后角膜植片透明率:术后1a89.8%,术后2a83.7%,术后3a78.3%,术后4a67.1%,术后5a63.6%。术后5a时圆锥角膜角膜植片透明率最高,达94.1%,角膜内皮功能失代偿最低,为14.3%。术后最佳矫正视力0.05～1.0,0.8以上者圆锥角膜所占比例最多,达72.5%,角膜内皮功能失代偿最少,占6.3%。导致角膜植片混浊的主要原因为角膜植片免疫排斥及角膜植片内皮细胞功能失代偿。结论:增视性PKP术后角膜植片透明率逐年稳定下降,相邻两年之间无显著性差异;原发病不同,角膜植片透明率有差异,圆锥角膜手术效果最佳;角膜植片混浊的主要原因为免疫排斥及角膜植片内皮功能失代偿。

AIM：To study the transparent rate of corneal graft and its influencing factors after optical penetrating keratoplasty（PKP）.METHODS：A retrospective study was done to 97 cases（105 eyes） in Qingdao Eye Hospital between January 2004 and December 2005 who had accepted optical PKP for keratoconus,corneal stroma dystrophy,corneal leukoma caused in ocular trauma or infection,herpes simplex keratitis（HSK）,corneal endothelial function decompensation and so on.Best-corrected visual acuity（BCVA） of preoperative and postoperative,graft clarity,allograft reactions,final postoperative visual acuity and complications leading to graft opacity were reviewed and statistically analyzed.RESULTS：The transparent rate of corneal graft were respectively 89.8% after 1 year,83.7% after 2 years,78.3% after 3 years,67.1% after 4 years,and 63.6% after 5 years.The best graft clarity was in eyes with an original diagnosis of keratoconus（94.1%） and the worst was in eyes with corneal endothelial function decompensation（14.3%） at postoperative 5 years.The BCVA after PKP was between 0.05 and 1.0,keratoconus accounted for the largest proportion（72.5%） of whom achieved 0.8 or better,and corneal endothelial function decompensation accounted for the smallest proportion（6.3%）.Graft immunological rejection and corneal allograft endothelial function decompensation were the leading causes of allografts opacity.CONCLUSION：The transparent rate of corneal graft decreases year by year stably after optical PKP.There is no significant difference between adjoining two years.There are differences in the transparent rate of corneal graft from different primary diseases.The result of kereatoconus is better than others.Graft immunological rejection and corneal allograft endothelial function decompensation are the leading causes of allografts opacity.