2006年至2015年角膜移植手术适应症及手术方式变化趋势的研究

A study of the trend of adaptation and hand style changes in corneal transplantation from 2006 to 2015

目的探讨角膜移植手术适应症及手术方式的变化趋势。方法选取2006年1月至2015年12月于厦门大学附属厦门眼科中心行角膜移植手术的患者2476只眼的临床资料。对患者的性别、年龄、手术适应症及手术方式等数据进行统计分析。根据国内外学者的调查结果,将角膜移植手术适应症分为感染性角膜炎、眼外伤、大泡性角膜病变、再次角膜移植、圆锥角膜、角膜肿瘤、角膜变性或营养不良、蚕蚀性角膜溃疡及其他角膜病变等九种类型。手术方式分为穿透性角膜移植和板层角膜移植两类。根据移植替换部位的不同,将板层角膜移植进一步分为前板层角膜移植和内皮移植。结果在2476只眼角膜移植手术中,感染性角膜炎1067只眼,占总眼数的43.09%;眼外伤446只眼,占总眼数的18.01%;大泡性角膜病变201只眼,占总眼数的8.12%;再次角膜移植183只眼,占总眼数的7.39%;圆锥角膜140只眼,占总眼数的5.65%;角膜变性及营养不良124只眼,占总眼数的5.01%;角膜肿瘤123只眼,占总眼数的4.97%;蚕蚀性角膜溃疡101只眼,占总眼数的4.08%;其他角膜病变91只眼,占总眼数的3.67%。单纯疱疹病毒性角膜炎535只眼,占感染性角膜炎总眼数的50.14%;真菌性角膜炎261只眼,约占24.46%;细菌性角膜炎258只眼,约占24.18%;阿米巴病毒性角膜炎13只眼,约占1.21%。穿透性角膜移植1479只眼,占总眼数的59.73%;前板层角膜移植935只眼,占总眼数的37.76%;内皮移植62只眼,占总眼数的2.50%。结论感染性角膜炎在角膜移植中最为常见,其次为眼外伤和大泡性角膜病变。单纯疱疹病毒性角膜炎在感染性角膜炎中最为常见。穿透性角膜移植是进行角膜移植最常用的手术方式,前板层角膜移植的临床应用比例逐年升高,内皮移植呈现平稳发展趋势。

Objective To discuss the changes in the indications and the mode of operation of corneal transplantation. Methods The clinical data of 2476 eyes with corneal transplantation from January2006 to December 2015 at the Xiamen ophthalmology center of Xiamen University were selected. The data of the patient ＇ s sex,age,the diagnosis of the primary disease and the mode of operation were analyzed.According to the survey results of scholars at home and abroad,the corneal transplantation indications into infectious keratitis,ocular trauma,bullous keratopathy,corneal transplantation,again keratoconus,corneal tumors,corneal deformation or malnutrition,Mooren ＇ s ulcer and other nine. The surgical methods were divided into two types,penetrating keratoplasty and lamellar keratoplasty. The lamellar keratoplasty was further divided into the anterior lamellar keratoplasty and the endothelial transplantation according to the different replacement parts. Results In 2476 eyes, corneal transplantation, infectious keratitis in1067 eyes,the total number of 43. 09%; ocular trauma in 446 eyes,the total number of 18. 01%; bullous keratopathy in 201 eyes,the total number of 8.12%; again the corneal transplantation in 183 eyes,the total number of 7.39%; the cone angle of film 140 the total number of eyes,5. 65% eyes; corneal degeneration and malnutrition in 124 eyes,the total number of 5.01% eyes of corneal tumor; 123 eyes,the total number of 4.97%; Mooren＇s ulcer in 101 eyes,the total number of 4.08%; other corneal lesions in 91 eyes,the total number of 3.67%. Herpes simplex keratitis 535 eyes accounted for 50.14% of the total number of infectious keratitis,261 cases of fungal keratitis,accounting for 24.46%,258 cases of bacterial keratitis,accounting for 24.18%,and amoebic viral keratitis 13 eyes,accounting for 1.21%. Penetrating keratoplasty 1479 eyes accounted for 59.73% of the total number of eyes. 935 eyes of the anterior lamellar keratoplasty accounted for37.76% of the total number of eyes,and 62 eyes of endothelial transplantation accounted for 2. 50% of the total number of eyes. Conclusions Infectious keratitis is the most common in corneal transplantation,followed by ocular trauma and bullous keratopathy. Herpes simplex keratitis is most common in infectious keratitis. Penetrating keratoplasty is the most common way of keratoplasty. The proportion of clinical application of anterior lamellar keratoplasty is increasing year by year,and endothelial transplantation is developing steadily.