板层角膜移植术后植片上皮延缓愈合的相关因素分析

Factors associated with delayed epithelial healing in early stage after lamellar keratoplasty

目的探讨板层角膜移植术(LKP)术后植片上皮延缓愈合的相关影响因素,以期指导临床治疗。方法回顾性病例研究。收集2008年6月至2012年6月于山东省眼科医院行LKP的患者217例(217只眼),详细记录所有患者的原发病种类、年龄、泪液分泌功能、病变累及角膜缘、移植片直径、移植片保存方法、植片上皮愈合时间等,并将植片上皮愈合时间>7 d归为上皮愈合延缓,并对这些病例资料分别从上述因素分类进行统计学分析。结果 217例患者中植片上皮延缓愈合的有59例(27.19%),其中感染性角膜炎患者24例(25.81%),非感染性非烧伤患者14例(14.00%),烧伤患者21例(87.5%),3组病例术后植片上皮愈合时间两两比较均有显著性差异(P<0.05);随年龄增长,>60岁组的植片上皮愈合时间较≤20岁组、21～40岁组和41～60岁组明显延迟(P<0.05);术前泪液分泌减少[植片上皮愈合时间,Shirmer Test<5为(16.25±11.30)d,Shirmer Test≥5为(4.21±4.26)d,P<0.05]以及病变累及角膜缘[累及角膜缘者愈合时间为(10.32±10.26)d,未累及角膜缘者为(4.67±4.31)d,P<0.05]与术后植片上皮延缓愈合有关;移植片直径≥9 mm的患者较7.25～8.75 mm组和≤7 mm组的患者植片上皮愈合时间明显延长(P<0.05);移植片予地塞米松(DX)液和甘油保存液保存行LKP术后植片上皮愈合时间比较,差异无统计学意义(P>0.05)。结论 LKP术后植片上皮延缓愈合与患者眼部病变种类、年龄大、泪液分泌量、病变是否累及角膜缘以及植片直径有关,而移植片的保存方法对上皮愈合无明显影响。

Objective To determine the factors associated with delayed epithelial healing eady after lamellar kera- toplasty. Methods This is a retrospective case study. Medical histories of 217 patients who undea-went lamellar kemto- plaaty at Shandong Eye Hmpital between June 2008 and June 2012 were collected. Information of ages, etiologies, Shinner test results, limbus involvement, graft diameters, storage time of done cornea, and epithelial healing time were obtained. Patients whose graft epithelium healed later than 7 days after surgery were defined as delayed epithelial healing and wexe further analyzed. Results Fifty nine [ 27.19% } cases of delayed epithelium healing were identified. In these cases, eti- ologies included infection （ 24 cases, 25.81% ）, bumlng （ 21 cases, 87.50% ）, and other noninfectious non - burning eti- dogies （ 14 cases, 14. 00% ）. Epithelium healing time was significantly different among those gnmps （ P 〈0. 05 ）. Epi- thelium healing time of the elders （ ≥61 years old） were significantly longer when compared to those of adolescents （ ≤20 years old）, young adults （21 -40 years old） and adults （41 -60） { P 〈0.05）. Deficits in Shinner test results and in- volvement of limhtls were associated with longer healing time. Specifically, patients with Shirmer test 〈 5 had a mean heal- hag time of 16.25 ± 11.30 days, while those with Shirmex test ≥5 had a mean healing time of 4.21 ±4.26 days. Patients with limhtts involved had a mean healing time of 10. 32± 10.26 days, while those didn had ｜imhtts involvement had a mean healing time of 4.67 ＋4.31 days. The epithelium healing time was also deayed in patients who received grafts that were 39mm in diameter, when compared to those transplanted with grafts 7.25 -8.75 mm in diameter, or ≤7 ,am in di- aumter. Whether donor corneas were stored in glycerin or in DX did not affect healing time significantly. Conclusion The graft epithelium healing is affected by original condition that evoked the lamellar keratoplasty, recipients＇age, Shirmer Test results, whether or not limhus was involved, and graft size. It was not relatod to donor cornea storage methods.