二次穿透性角膜移植术后失败原因分析

Etiology for the failure of repeat penetrating keratoplasty

目的探讨二次穿透性角膜移植术(PKP)术后失败的原发病因及直接原因。方法回顾性病例研究。选择2003年1月至2010年1月于山东省眼科研究所青岛眼科医院行二次PKP患者的临床资料100例(100只眼),统计分析失败患者的原发病因及直接原因。结果本文中行二次PKP术后病例共计100例,其中失败病例37例,失败率为37%。不同原发病因行二次PKP术后失败的数量依次为:化脓性角膜炎(11只眼,29%)、眼外伤(10只眼,27%)、单纯疱疹病毒性角膜炎(7只眼,19%)、蚕食性角膜溃疡(5只眼,14%)、大泡性角膜病变(2只眼,5%)、角膜变性及营养不良(1只眼,3%)、角膜白斑(1只眼,3%)。引起二次PKP术后失败的直接原因依次为:植片免疫排斥(17只眼,45%)、角膜内皮细胞功能失代偿(8只眼,22%)、角膜植片溃疡(7只眼,19%)、原发病复发(4只眼,11%)、角膜植片溶解(1只眼,3%)。结论二次PKP术后失败的原发病因以化脓性角膜炎为主,直接原因主要是免疫排斥。

Objective To explore the primary diseases and the direct reasons for the failure of repeat penetrating keratoplasty（PKP）.Methods 100 patients（100 eyes） who undergo repeat PKP in Qingdao Eye Hospital from January 2003 to January 2010 were retrospected,analyze primary diseases and direct reasons for the failures of them.Results A total of 100 patients（100 eyes） were investigated,37 cases failed after repeat penetrating keratoplasty,The failure rate was 37%.The primary disease of failure of repeat PKP in order of decreasing frequency,were suppurative keratitis（11 eyes,29%）,ocular trauma（10 eyes,27%）,herpes simplex keratitis（7 eyes,19%）,Mooren＇s ulcer（5 eyes,14%）,bullous keratopathy（2 eyes,5%）,corneal dystrophy and degeneration（1 eye,3%）,corneal leukoma（1 eye,3%）.The direct reasons for the failure of repeat penetrating keratoplasty in order of decreasing frequency,were graft rejection（17 eyes,45%）,corneal allograft endothelial function decompensation（8 eyes,22%）,corneal graft ulceration（7 eyes,19%）,and recurrence of primary diseases（4 eyes,11%）,graft dissolution（1 eye,3%）.Conclusion Suppurative keratitis is the major primary disease of failure of repeat PKP,and the direct reasons was graft rejection.