深板层角膜移植术治疗瘢痕期病毒性角膜炎

Deep lamellar keratoplasty for treating viral keratitis in scaring period

目的分析深板层角膜移植术治疗瘢痕期病毒性角膜炎的临床效果。方法临床诊断明确的瘢痕期病毒性角膜炎48例（48只眼）。均有不同程度及大小的角膜白斑和基质层的新生血管，部分患眼伴有角膜基质水肿，视力均低于0．1。术前给予积极的局部和全身糖皮质激素和抗病毒治疗，然后行深板层角膜移植术，术后随访2～48个月，观察视力、植片透明度、复发率及术中术后并发症。结果3只眼术中发生后弹力层破裂，其中2只眼行前房注气术后植片与植床贴服良好，1只眼术中改为穿透性角膜移植术，其余45只眼均接受深板层角膜移植术，手术均顺利，1只眼术后1个月更换角膜植片，3只眼复发未及时随访治疗导致植片浑浊血管化，经治疗恢复透明，4只眼出现上皮型免疫排斥反应，经积极治疗后植片恢复透明。所有术眼视力均有不同程度的提高，最佳矫正视力≥0．25者13只眼，0．12～0．2者15只眼，≤0．1者20只眼。结论深板层角膜移植术可以比较有效地治疗瘢痕期病毒性角膜炎，后弹力层的瘢痕和皱褶是影响术后视力恢复的主要原因，因此对于瘢痕期病毒性角膜炎应早行手术治疗。

Objective To evaluate the clinical efficacy of the deep lamellar keratoplasty （DLKP） in the treatment of viral keratitis in scaring period. Methods DLKP was performed on 48 eyes of 48 cases of viral keratitis in scaring period which was complicated with corneal scarring, edema and vaseularized stro- ma. All the eyes had visual acuity 〈 0.1 and were treated by local and systemic antiviral therapy before sur- gery, and then the DLKP were performed. A follow-up arranging from 2 to 48 months was conducted to in- vestigate the visual acuity, condition of graft, surgical complications and the postoperative recurrent rate. Results 45 cases were successfully treated by standard DLKP. Three cases were complicated with tear of Descemet＇ s membrane. In which two cases were treated by gas injection in anterior chamber. And the graft attached to the bed successfully. And one case was treated by penetrating keratoplasty. The postoperative complications were stated as follows. One case received a changed graft, 3 cases occurred with viral recur- rence, and 4 cases occurred with epithelial rejection. All grafts turned transparent after further treatment. The best corrected visual acuity achieved 0.25 or better in 13 cases, 0.12 to 0.2 in 15 cases and no better than 0.1 in 20 cases. Conclusion DLKP is an effective treatment for viral keratitis. The wrinkles and scar in the Descemet＇ s membrane is the mean cause of reduced visual acuity after surgery. An early operation for viral keratitis in scaring period is recommended.