自体板层角膜瓣转位移植术治疗旁中心角膜溃疡穿孔的临床观察

Autologous ipsilateral lamellar corneal-flap transposition for treatment of peripheral corneal ;perforation

目的：探讨自体板层角膜瓣转位移植术治疗旁中心角膜溃疡穿孔的临床效果。方法回顾性系列病例研究。选择2008年1月至2015年2月收治的角膜溃疡穿孔患者13例（13只眼），溃疡直径≤3.0 mm,穿孔直径≤2.0 mm，采取自体板层角膜瓣转位移植术治疗。观察术后视力恢复、角膜散光状态的变化、溃疡愈合情况、角膜植片和植床透明度。随访3～12个月，平均8个月。对术前、术后3个月最佳矫正视力、角膜散光进行配对t检验。结果13例患者（13只眼）术后第1天前房形成，瞳孔无粘连，植片与植床对合良好，角膜植片有轻到中度的水肿混浊。术后第7～14天，角膜水肿基本消退，移植片基本透明，溃疡边界模糊。术后3个月角膜植片基本透明，所有病例溃疡未见复发。术前最佳矫正视力0.44±0.19。术后3个月拆除角膜缝线的最佳矫正视力为0.47±0.20，两者相比，差异无统计学意义（t=0.706, P=0.461）。术前角膜散光（4.12±2.06）D。术后3个月拆除角膜缝线后角膜散光为（2.52±0.87）D，两者相比，差异具有统计学意义（t=2.391, P〈0.05）。结论自体板层角膜瓣转位移植术治疗旁中心角膜溃疡穿孔安全有效，是供体角膜缺乏地区或是有高危角膜移植患者的有效替代疗法，但其手术适应证范围较窄。（中华眼科杂志，2016，52：663-668）

Objective To study the clinical outcome of autologous ipsilateral lamellar corneal-flap transposition for treatment of peripheral corneal perforation. Methods Medical records of 13 patients who underwent autologous ipsilateral lamellar corneal-flap transposition for peripheral corneal perforation from January 2008 to February 2015 were retrospectively reviewed. The diameter of the corneal ulcers was all ≤3.0 mm, and the diameter of perforations was all ≤2.0 mm. All patients were followed up for 3-12 months with an average of 8 months. The healing of ulcer, clarity of the grafts, pre-and postoperative visual acuity, and astigmatism were documented and analyzed. Results At 1 day after surgery, all patients had normal anterior chamber depth without aqueous leak. No double chamber or iris synechia was found. The corneal grafts showed mild to moderate edema. On postoperative days 7-14, the corneal edema receded, the grafts became transparent gradually, and the ulcer margin was blurred. Three months after surgery, all the grafts remained transparent. There was no recurrence of ulcer during the follow-up period. The best corrected visual acuity before and after surgery was 0.44 ± 0.19 and 0.47 ± 0.20, respectively, which indicated no statistically significant difference（t=0.706, P=0.461）. The corneal astigmatism before and after surgery was 0.44±0.19 and 0.47±0.20, respectively, which showed statistically significant difference（t=2.391, P〈0.05）. Conclusions Autologous ipsilateral lamellar corneal-flap transposition is a safe and effective surgical procedure for treating peripheral corneal perforation. It can be considered as an alternative method for penetrating or lamellar keratoplaty when the availability of corneal tissue is limited, or for cases with a high risk of developing immunologic allograft rejection, although the surgical indications are limited.