治疗性深板层角膜移植术治疗感染性角膜炎伴微穿孔临床疗效分析

Clinical analysis of therapeutic deep anterior lamellar keratoplasty in the treatment of infectious keratitis with microperforation

目的探讨治疗性深板层角膜移植(TDALK)术治疗微穿孔的感染性角膜炎的临床疗效。方法选取2016—2019年北部战区总医院收治的17例(17眼)感染性伴微穿孔角膜炎患者为研究对象。所有患者均经TDALK术进行治疗。比较患者术前及术后1、3、6个月的视力,并观察术后并发症情况。结果17例患者术前及术后1、3、6个月的视力分别为(1.96±1.14)、(1.69±0.97)、(1.02±0.52)、(0.44±0.26);术后1个月视力与术前比较,差异无统计学意义(P>0.05);术后3、6个月的视力与术前比较,差异均有统计学意义(P<0.05);术后1个月与术后3个月视力比较,差异无统计学意义(P>0.05);术后6个月视力较术后1、3个月均有明显提高,差异有统计学意义(P<0.05)。17眼术后均恢复眼球完整性,随访期间出现层间积液1例、高眼压1例、植片排斥1例,但通过短期治疗均痊愈,且未再次发生感染。结论TDALK治疗微穿孔的感染性角膜炎安全、有效,可控制感染,恢复患者眼球完整性。

Objective To investigate the clinical efficacy of therapeutic deep anterior lamellar keratoplasty(TDALK)in the treatment of infectious keratitis with microperforation.Methods Seventeen patients(17 eyes)with infectious microperforation keratitis who were admitted from 2016 to 2019.All patients were treated with TDALK.The visual acuity of the patients before and after 1,3 and 6 months were compared,and the postoperative complications were observed.Results The visual acuity of 17 patients was(1.96±1.14),(1.69±0.97),(1.02±0.52)and(0.44±0.26)before and after surgery for 1,3 and 6 months,respectively.There was no significant difference in visual acuity between 1 month after surgery and that before surgery(P>0.05).The visual acuity at 3 and 6 months after surgery was significantly different from that before surgery(P<0.05).There was no significant difference in visual acuity between 1 month after surgery and 3 months after surgery(P>0.05).Visual acuity at 6 months after surgery was significantly improved compared with that at 1 and 3 months after surgery(P<0.05).The integrity of the eyeball was restored in all 17 eyes after the surgery,and 1 case of interlamellar effusion,1 case of high intraocular pressure and 1 case of graft rejection occurred during the follow-up.However,patients were all cured after short-term treatment,and no re-infection occurred.Conclusion TDALK is safe and effective in the treatment of microperforated infectious keratitis,which can control the infection and restore the integrity of the patient's eyeball.