角膜移植315例患者的原发疾病谱及手术方式选择

Keratoplasty classification and primary disease spectrum analysis of 315 cases

目的了解角膜移植手术患者的原发疾病谱以及手术方式的选择。方法回顾性系列病例研究。收集2012年1月至2015年12月华中科技大学附属同济医院眼科行角膜移植手术的角膜病患者的病历资料，统计分析接受移植手术患者的年龄、性别、籍贯、原发角膜疾病及手术方式。结果4年间共有315例角膜病患者接受角膜移植手术，患者的年龄最小1个月3天，最大89岁，平均（42．0±1．8）岁，其中229例（72．7％）在18～65岁之间；男女比例为2．06：1。共计289例（91．8％）患者来自湖北省，26例（8．2％）患者来自湖北省外。所有角膜病患者中占首位的角膜疾病为感染性角膜炎，共125例（39．7％），其余依次为角膜白斑71例（22．5％），圆锥角膜41例（13．0％），大泡性角膜病变26例（8．3％），角膜皮样瘤18例（5．7％），角膜变性与营养不良16例（5．1％）及其他（包括化学伤、热烧伤、外伤后角膜瘢痕及角膜植片混浊）18例（5．7％）。在125例感染性角膜炎中，真菌性角膜炎51例（40．8％），病毒性角膜炎43例（34．4％），细菌性角膜炎24例（19．2％）。按照角膜移植手术分类，穿透性角膜移植术为212例（67．3％），板层角膜移植术87例（27．6％），角膜内皮移植术16例（5．1％）。结论在同济医院角膜移植患者的原发角膜病中，感染性角膜炎占首位，其余依次为角膜白斑、圆锥角膜和大泡性角膜病变，而真菌则是感染性角膜炎的首位病因。在手术方式的选择上，穿透性角膜移植术为主要术式。

Objective To identify the primary disease spectrum and trends of surgical procedure of keratoplasty patients. Methods Retrospective case series study. To review all patients who underwent keratoplasty at Department of ophthalmology in Tongji Hospital from January 1, 2012 to December 31, 2015. The data collected included age, sex, birthplace, and primary corneal disease and associated surgical procedures. Then the data were compared with similar papers domestic and foreign. Results A total of 315 keratoplasties were performed during this 4-year period. The average age of patients at time of surgery was （42.0±1.8） years, range from 33 days to 89 years, 229 cases （72.7%） were from 18 to 65 years; male： female ratio was 2.06：1. Totally 289 cases （91.8%）came from Hubei province, 26 cases （8.2%） were from other provinces. The leading indications for corneal transplantation were keratitis in 125 cases （39.7%）, followed by corneal scar in 71 cases （22.5%）, keratoconus in 41 cases （13.0%）, pseudophakic bullous keratopathy in 26 cases （8.3%）, corneal dermoid in 18 cases （5.7%）, corneal dystrophy and degeneration in 16 cases （5.1%）, and others （including chemical injuries, thermal burns, post-traumatic corneal scar and corneal opacity） in 18 cases （5.7%）. Of the 125 keratitis cases, 51 cases （40.8%）were associated with fungus, 43 cases （34.4%）were associated with virus, and 24 cases （19.2% ）were associated with bacterial. In accordance with the classification of corneal transplant surgery, penetrating keratoplasty was performed in 212 cases （67.3%）, lamellar keratoplasty was completed in 87 cases （27.6%）, corneal endothelial transplantation was made in 16 patients （5.1%）. Coneltmions Infectious keratitis was the leading indication for corneal transplantation followed by corneal scar, keratoconus and pseudophakic bullous keratopathy in Tongji hospital patients who underwent keratoplasty. And fungus was the first cause of infectious keratitis. Penetrating keratoplasty was still the main part of corneal transplantation.