46例穿透性角膜移植术的改进

Improveing prognosis in penetrating keratoplasty

目的 :探讨穿透性角膜移植术全过程中改善移植预后的方法。方法 :在 46例穿透性角膜移植过程中 ,注意手术过程中的各个环节 ,包括 :新鲜或保存良好的供体角膜 ;手术过程中采用多种方法保护角膜内皮细胞 :剪取供体植片时前房注入 10 g/ L 玻璃酸钠 ,内皮侧冲切制作植片 ,将植片预置缝合 6针固定于植床再用 10 g/ L玻璃酸钠及眼用平衡盐溶液 (BSS)形成前房 ;适时拆线防止排斥反应的发生 ;及早治疗移植排斥反应。结果 :术后随访 3～ 36个月 ,46眼中 42眼(91.3% )角膜透明愈合 ,4眼 (8.7% )角膜混浊。结论 :保证充足角膜内皮数的供体角膜 ,精细的手术减少角膜内皮细胞的损伤 ,预防和及早治疗术后排斥反应 ,是可以改善穿透性角膜移植预后的。

Objective:[WT5”BZ]Introduce some ways improving prognosis during penetrating keratoplasty(PKP).Methods:We performed PKP in 46 eyes successfully by some ways which include using fresh or well preserved donor cornea.Sodium hyaluronate 10 g/L (SH) injeced into the anterior chamber of the donor eye prior to traphination.Punching donor corneal discs from the endotheline side,fixating the cornea discs to the recipent bed by 6 cardnal suture in place,ensuring an even tension on the graft,keeping the anterior chamber by injecting 10g/L SH or BSS again,removing suture whenever they were indicated.Preyenting rejection and treating carneal rejection as earlier as it occur.[WT5”HZ]Results:[WT5”BZ]Patients were followed for 3～36 months.Corna in 42 (91.3%) out of 46 recipent eyes keeps transparent and other corneas in 4 eyes (8.7%) were opacity.[WT5”HZ]Conclusion:[WT5”BZ]with well presorved donor cornea with adequate endothelium and delicate procedures can reduce damage to the endothelium.Furthermore,prevention and trentment of rejection as earlier as possible can improve the prognosis. [WT5”BZ]