部分板层角膜移植术后层间积液的发病特征及处理

Causes and treatment of interface fluid after partial lamellar keratoplasty

目的探讨部分板层角膜移植（LKP）术后早期角膜层间积液的发病特征，并观察层问放液法的治疗效果。方法回顾性系列病例研究。山东省眼科医院433例部分LKP患者中38例发生术后早期角膜层间积液，分析发生积液与不发生积液患者术前原发病、角膜供体材料的保存方法以及角膜植片与植床直径的差异。对发生层间积液的患者在显微镜下行角膜层间放液治疗，观察治疗效果。数据采用卡方检验进行分析。结果38例（8．8％）部分LKP术后发生层间积液的患者中，圆锥角膜LKP术后发生层间积液的风险（15．9％）远远高于其他疾病。甘油冷冻保存供体层间积液发生率（10．4％）与DX液保存供体引起层间积液的发生率（4.3％）相比，差异有统计学意义（x2=4．060，P〈0．05）；甘油保存3年以上供体层间积液发生率（17．7％）与3年以内供体层间积液发生率（9.3％）差异有统计学意义（x2=12．152，P〈0．01）。植片〉植床0．5mm者（19．5％）较植片〉植床0．25mm者（7．7％）更易发生积液（X2=6．521，P〈0．05）。应用角膜层间放液法治疗后行裂隙灯检察，层间积液消失，植片植床相贴附，术后1周角膜植片均可恢复透明。1例圆锥角膜患者出现层间大量积液、瞳孔阻滞、继发性青光眼，急诊行虹膜周切术，解除瞳孔阻滞，病情得到控制。结论圆锥角膜行部分LKP术后层间积液的发生率高于其他疾病，甘油长期保存角膜供体、角膜植片对植床周边部的过度压迫是引起层间积液的重要因素；术后早期观察并及时采用层间放液法可以有效治疗角膜层间积液。

[Abstract] Objective To investigate the clinical features of interface fluid at an early stage after partial lamellar keratoplasty （LKP） and observe the therapeutic effect of releasing interface fluid. Methods This was a retrospective, noncomparative clinical trial. Thirty-eight patients with onset of interface fluid were identified among 433 patients who underwent partial LKP at Shandong Eye Hospital from September 2007 to January 2011. Examinations were conducted 2 to 4 hours after surgery. The primary disease, the preservation of donor corneal tissue, and the size difference between the corneal graft and the recipient bed of the patients with interface fluid were assessed. The interface fluid was released immediately under a microscope, and the effect was evaluated. Data were analyzed using X2 test. Results Interface fluid was found in 38 cases （8.8%） at 2 to 4 hours after LKP, including 18 cases of keratoconus, which was significantly more than the other diseases. The rate of interface fluid in patients whose donor corneas were preserved in glycerin （10.4%） was higher than the rate in donor tissue preserved in a DX solution （4.3%, ~2=4.060, P〈0.05）. The rate of interface fluid in donor tissue preserved in glycerin more than 3 years （17.7%） was higher than that preserved for less than 3 years （9.3%, ~2=12.152, P〈0.01）. Corneal grafts 0.5 mm or larger than the recipient bed induced more interface fluid （19.5%） than those 0.25 mm or larger （7.7%, x2=6.521, P〈0.05）. The graft and recipient bed attached tightly after the fluid was released, and regained transparency 1 week later. However, a large amount of interface fluid was found in 1 patiezlt the day after LKP.