719例角膜移植术角膜病分类及手术方式的回顾性分析

Retrospective Analysis of Corneal Disease Classification and Surgical Methods in 719 Cases of Keratoplasty

目的了解我国中部地区角膜移植手术患者的原发疾病谱及流行病学特征,并比较手术方式选择的变化趋势。方法回顾性分析2014年1月~2018年12月在同济医院眼科接受角膜移植手术的角膜病患者资料。对其年龄、性别、原发角膜疾病及手术方式进行统计,并与已发表的国内、外相关研究进行比较。结果5年间共有719例角膜病患者接受角膜移植手术,平均年龄(44.49±1.70)岁,患者的年龄最小33 d,最大89岁,其中518例(72%)在18~65岁之间;男女比例为1.68∶1。感染性角膜炎是其中占首位的角膜疾病(306例,42.6%),其余依次为角膜白斑(154例,21.4%)、圆锥角膜(85例,11.8%)、大泡性角膜病变(63例,8.8%),角膜变性与营养不良(39例,5.4%)、角膜皮样瘤(32例,4.5%)及其他(如化学伤、热烧伤、外伤后角膜瘢痕及角膜植片混浊等,38例,5.3%)。在306例感染性角膜炎中按病因依次排序为:真菌性角膜炎(149例,48.7%)、病毒性角膜炎(98例,32.0%)、细菌性角膜炎(59例,19.3%)。按照角膜移植手术方式分类,最多的是穿透性角膜移植术(443例,61.6%),其余为板层角膜移植术(243例,33.8%)、角膜内皮移植术(32例,4.5%)。结论我国中部地区角膜移植术患者的原发角膜病中,感染性角膜炎占首位,其余依次为角膜白斑、圆锥角膜和大泡性角膜病变,而真菌则是感染性角膜炎的首位病因。穿透性角膜移植仍为角膜移植的主要术式,板层及角膜内皮移植手术量的上升趋势不容忽视。

Objective To identify the spectrum of primary diseases and epidemiological characteristics of keratoplasty patients in the central region of China,and to compare the trend of transplantation types.Methods Patients who received keratoplasty in Tongji Hospital from January 2014 to December 2018 were enrolled in this retrospective study.The data collected included age,gender,primary corneal disease and associated surgical procedures.Then,it should be analyzed statistically and compared with the published domestic and foreign results.Results Totally,719 patients received keratoplasty within 5 years.The average age of patients was(44.49±1.70)years,ranging from 33 days to 89 years,518 cases(72%)were from 18 to 65 years.The ratio of male to female was 1.68∶1.The leading indications for corneal transplantation were keratitis,(306 cases,42.6%),followed by corneal leucoma(154 cases,21.4%),keratoconus(85 cases,11.8%),pseudophakic bullous keratopathy(63 cases,8.8%),corneal dystrophy and degeneration(39 cases,5.4%),corneal dermoid(32 cases,4.5%),and others(including chemical injuries,thermal burns,post-traumatic corneal scar)(38 cases,5.3%).Among the 306 cases of infectious keratitis,48.7%(149 cases)were fungal keratitis,32.0%(98 cases)were viral keratitis and 19.3%(59 cases)were bacterial keratitis.According to the classification of corneal transplantation methods,there were 443 cases of penetrating keratoplasty(PKP)(61.6%),243 cases of lamellar keratoplasty(LKP)(33.8%),32 cases of corneal endothelial transplantation(EK)(4.5%).Conclusion Infectious keratitis is the leading indication for corneal transplantation in Central China,followed by corneal leucoma,keratoconus and bullous keratopathy,and fungus is the most common cause of infectious keratitis.PKP is still the most popular corneal transplantation method,but a trend of LKP and EK rising up should be noticed.