272例施行穿透性角膜移植术原因的调查分析

Analysis of etiologies in 272 patients received keratoplasty

目的探讨施行穿透性角膜移植术(PKP)的原因及其变化趋势。方法选择符合穿透性角膜移植手术适应症标准并行穿透角膜移植术的272例病例,分析行角膜移植患者的致病原因及变化趋势。结果角膜移植术病因以角膜白斑占首位(44.12%),其余依次为感染性角膜炎(约20.59%),角膜化学伤及热烧伤(约8.82%)、遗传相关的角膜营养不良和角膜变性、圆锥角膜、大泡性角膜病变、角膜破裂伤、再次角膜移植术者及其他。在调查期内,角膜白斑始终占角膜移植病因首位,数量和比重没有明显变化,感染性角膜炎和角膜化学伤及热烧伤的数量和比重在下降,圆锥角膜、大泡性角膜病变患者数量在逐步增加。其余病因变化不明显。形成角膜白斑的首要病因是真菌性角膜疾病(约46.28%)。真菌感染患者一直居感染性角膜炎病因首位,但绝对数量在下降,而所占比重在上升。年龄分布以中青年组为主。结论角膜白斑是穿透性角膜移植的主要病因,真菌性角膜疾病是导致角膜白斑的主要原因,并呈上升趋势。圆锥角膜和大泡性角膜病变在逐年增多。

Objective To examine the major causes and identify trends of penetrating keratoplasities （PKP） per- formed in Guangxi in the past five years. Methods A total of 272 patients （ 272 eyes ）, who received PKP in No. 303 Hospital of People~ Liberation Army between January 1,2008 and December 31,2012 were res4ewed. The initial diagnosis and causes of re-grafting were noted. The trend of changes in causes was analyzed. Rrsults A total of 272 cases were in- eluded in this study. The leading indications for PKP, in order of decreasing frequency, were corneal scar （44.12%）, in- fectious keratitis （ 20.59% ）, thermal and chemical bum （ 8.82% ）, corneal dystrophy and degeneration, keratoconus, bullous keratopathy, penetrating corneal trauma, re-graft and others. During the period of investigation, corneal leukoma has been always the most common cause for PKP. The number and proportion of infected keratitis and chemical and thermal burns decreased, while the number and proportion of keratoconus and bullous keratopathy gradually increased. The primary cause of the corneal scar is fungal diseases （46.28% ）. Fungal infection has been the top etiology in infectious keratifis, but the number is declining, although the proportion is rising, and it mostly occurred in young patiems. Conduslons Cor- neal scar is still the leading cause for PKP in Guangxi. Keratoconus and bullous keratopathy have shown a trend of increase. Keratoconus and bullous keratopathy are rising year by year.