穿透性角膜移植联合白内障摘出及人工晶状体植入术疗效观察

Clinical observation of a triple procedure of stimultaneous penetrating keratoplasty combined with extracapsular cataract extraction and intraocular lens implantation

目的评价同时行穿透性角膜移植、白内障囊外摘出联合人工晶状体植入术(简称三联手术)患者的手术效果,探讨三联手术术后角膜屈光力与术前晶状体度数的选择。方法 回顾性分析2016年4月至10月在北京佑安医院行三联手术的15例患者资料,观察患者术后1 a的最佳矫正视力(best corrected visual acuity,BCVA)、眼压、角膜屈光度、眼轴长度、并发症及角膜内皮细胞数以及植片存活情况。结果所有患者术后1a角膜植片均保持透明,角膜内皮细胞数为(1974.20±472.82)个·mm^(-2)。术后BCVA为(0.80±0.27)LogMAR,与术前(2.63±0.62)LogMAR相比,有显著性提高(t=13.042,P<0.001)。术后眼压为(14.53±3.04)mmHg(1 kPa=7.5 mmHg),与术前眼压(15.27±2.37)mmHg相比,差异无统计学意义(t=0.685,P=0.505)。术后眼轴长度为(23.62±2.12)mm,与术前(23.69±2 01)mm相比,差异无统计学意义(t=-0.138,p=0.893)。术后角膜屈光度为(42.56±5.48)D,与术前对侧眼(45.01±1.66)D相比,差异无统计学意义(t=1.202,P=0.260)。术前目标屈光度为(0.58±0.25)D,术后等效球镜度为(0.40±4.65)D。结论三联手术对于治疗伴有白内障的角膜疾病是一种安全有效的手术方式,术前选择预留偏正视的晶状体度数可能获得满意的术后视力,但术后不可预知的角膜曲率改变仍会对屈光状态造成影响。

Objective To evaluate the operative outcomes of a triple procedure including simultaneous penetration keratoplasty(PKP),extracapsular cataract extraction(ECCE)and intraocular lens(IOL)implantation,and to investigate the relationship between postoperative corneal refractive power and preoperative lens diopter.Methods This retrospective analysis study involved 15 patients who had undergone a triple procedure surgery in Beijing You’an hospital from April to October 2016.Outcomes including the best corrected visual acuity(BCVA),intraocular pressure(IOP),corneal refractive power,axial length,postoperative complications,corneal endothelial cell counts and the survival of corneal graft were determined one year after surgery.Results All corneal grafts were transparent and corneal endothelium were(1974.20±472.82)cell·mm-2.The mean postoperative LogMAR visual acuity(0.80±0.27)had a significant improvement compared with the mean preoperative LogMAR visual acuity(2.63±0.62)(t=13.042,P<0.001).There were no statistically significant differences in preoperative IOP(15.27±2.37)mmHg(1 kPa=7.5 mmHg)and postoperative data(14.53±3.04)mmHg(t=0.685,P=0.505),preoperative axial length(23.69±2.01)mm and postoperative data(23.62±2.12)mm(t=-0.138,P=0.893)and preoperative keratometry(45.01±1.66)D of the control eye and postoperative data(42.56±5.48)D(t=1.202,P=0.260).The postoperative spherical equivalent refractive was(0.40±4.65)D,and the target refraction was(0.58±0.25)D.Conclusion The triple procedures are safe and effective for the treatment of patients with coexisting corneal pathologies and cataracts.Selection of emmetropia lens diopter may result in the satisfactory postoperative visual acuity.However,unpredictable postoperative corneal curvature changes will still affect the final refractive state.