12岁以下儿童穿透性角膜移植手术的临床分析

Clinical analysis of penetrating keratoplasty for the children under 12 years old

目的分析儿童穿透性角膜移植术的病因、手术方式、植片透明率、排斥反应发生率及影响排斥反应的相关因素。设计回顾性病例系列。研究对象北京同仁眼科中心2008年1月至2013年12月穿透性角膜移植手术的12岁以下患儿81例(81眼)。方法根据年龄分为婴幼组(0~3岁,49眼)和儿童组(4岁~12岁,32眼)。术后平均随访(38.72±21.46)个月。回顾患者的病历资料。主要指标患者年龄、术前诊断、手术方式、术后植片透明度。结果病因主要为先天性角膜混浊占82.72%;后天外伤性占6.17%,后天非外伤性占11.11%(其中感染性角膜炎3.70%,圆锥角膜角膜3.70%、移植术后植片失败3.70%)。先天性角膜混浊在婴幼组占93.88%,儿童组占65.63%(P<0.01)。手术方式中单纯穿透性角膜移植术(PKP)占80.25%,其中婴幼组89.80%(44/49),儿童组75.00%(24/32)(P<0.05)。末次随访时总体植片透明率85.19%,其中婴幼组81.63%(40/49),儿童组90.63%(29/32)(P>0.05)。先天性因素者术后排斥率15.22%(7/46),后天性因素中活动性炎症导致角膜溃疡并穿孔(1/1)和植片失败进行再次角膜移植手术(3/3)的术后植片排斥率极高。结论 12岁以下儿童穿透性角膜移植的主要病因为先天性角膜混浊。虽然儿童角膜移植难度大,但仍具备一定的成功条件。儿童穿透性角膜移植植片存活率有所提高。

Objective To describe the etiology,and results of corneal graft after penetrating keratoplasty（PKP） in infants and young children, and to identify the risk factors for graft failure. Design Retrospective case series. Participants Eighty-one children（81eyes） aged below 12 years old who underwent PKP in Beijing Tongren Hospital between January 2008 and December 2013. Method Eighty-one children were divided into two groups： infant group（≤3 years old） and young children group（〉3 years,≤12years old）. All patients underwent PKP surgery. Mean follow-up time was 38.72±21.46 months. Main Outcome Measure Characteristics of the age, etiology, and the surgical procedure, graft clarity. Results The most common etiology for children PKP surgery included congenital corneal opacity 82.72%, acquired traumatic 6.17% and acquired nontraumatic 11.11%（infectious keratitis 3.70%, keratoconus 3.70%,graft failure 3.70%）. There were significant difference in the etiology of congenital corneal opacity between infant group（93.88%） and young children group（65.63%）（P〈0.01）. The rate of PKP is 80.25%. There were difference in rate of merely PKP between infant group89.80%（44/49）and young children group 75.00%（24/32）（P〈0.05）. The overall probability of maintaining a clear graft was 85.19%（69/81） at the last follow-up（infant group 81.63%, and young children group 90.63%, P〉0.05）. The rejection for congenital corneal opacity and sclerocornea was 12.31%. Eyes with the indications of corneal ulceration leading to perforation and graft rejection had significantly poor outcomes after the PKP. Conclusions The most common indications of PKP surgery for children under 12 years old was congenital corneal opacity. Although PKP is difficult in children, it has a reasonable chance of success. However, the anatomic success of PKP is increasing.