不同植片的光学性角膜移植的远期屈光变化

Unmatched corneal tranplant grafts and refractive changes over time

目的 :探讨不同植片的光学性角膜移植术的远期屈光变化。方法 :对圆锥角膜 ,病毒性角膜炎 ,外伤性、霉菌性等所致的角膜白斑、角膜营养不良采用不同大小的角膜植片行穿透性角膜移植手术 ,术后随访观察的时间为 10个月～ 8年 ,平均为 48个月。结果 :角膜植片直径≤ 7mm与 >7mm的两组术后散光产生差异有显著性 (P <0 .0 5 )。术后角膜散光轻微不影响视力者 2 4眼 (占 30 .8% ) ,散光明显者 5 4眼 (占 6 9.2 % ) ,其中不规则散光者 8眼 (占 14.8% ) ,顺规性散光者 2 5眼 (占 46 .3% ) ,逆规性散光者 2 1眼 (占 38.9% )。结论 :为避免角膜移植术后产生较大的散光 ,要尽量做到植床、植片边缘垂直整齐 ,选择性拆线和调线可作为术后散光矫正方法 。

Objective:To investigate the use of unmatched corneal implant grafts and refractive changes that occur over time.Methods:Retrospectively,76 cases(78 eyes) with keratoconus viral keratitis,traumatic mycosis caused by leukoma,and corneal dystrophy that underwent unmatched corneal grafts were observed from 10 months to 8 years,48 months on average.Results:There were marked differences in the measurement of astigmatism for post-surgical corneas ≤7 mm in radius and >7 mm in radius(P<0.05). Postoperatively,24 eyes(30.8%) had no significant astigmatism,54 eyes(69.2%) had strong astigmatism,8 eyes(14.8%) had oblique astigmatism,25 eyes(46.3%) had with-the-rule astigmatism and 21 eyes(38.9%) had against-the-rule astigmatism.Conclusion:The optics of corneal transplants were observed over a long period of time and refractive changes were analyzed. Only a few patients had reduced astigmatism postoperatively or improved corneal optics.