圆锥角膜急性角膜水肿治疗后深板层角膜移植临床分析

Clinical analysis of acute corneal edema types in keratoconus and deep lamellar keratoplasty

目的通过对圆锥角膜急性角膜水肿治疗后行深板层角膜移植的病例分析,探讨眼前节相干光层析成像术(AS-OCT)对急性圆锥治疗后行角膜移植手术的手术方式选择的指导意义。方法回顾性病例对照研究。收集2017年6月至2019年12月我院收治的圆锥角膜急性水肿患者32例(32只眼),均采用保守妥布霉素地塞米松眼膏包眼方法待瘢痕形成后行角膜移植,分析急性期AS-OCT影像与最终所行角膜移植手术方式的关系。结果32例圆锥角膜患者急性水肿期AS-OCT影像中后弹力层脱离伴破裂卷曲10例(31.250%),后弹力层脱离伴破裂15例(46.875%),单纯后弹力层脱离7例(21.875%);32例患者最终角膜移植手术方式,穿透角膜移植23例,深板层角膜移植9例(其中大气泡法5例,手剥法4例)。Spearman相关分析深板层角膜移植手术方式完成与无后弹力层破裂呈正相关r=0.605,95%,CI:0.456~0.730,(P<0.01)。结论圆锥角膜急性水肿期单纯后弹力层脱离的病例深板层角膜移植成功率高,AS-OCT对急性水肿期后圆锥角膜患者角膜移植方式的选择有指导意义。

Objective To explore the significance of anterior segment optical coherence tomography(AS-OCT)in the surgical methods choice for keratoplasty after acute corneal edema treatment.Methods A total of 32 keratoconus patients(32 eyes)with acute corneal edema treated in our hospital from June 2017 to December 2019 were enrolled for retrospective case-control study.All patients were treated with conservative hormone encapsulation and keratoplasty after scar formation.The relationship between the AS-OCT images in the acute phase and the final surgical method of keratoplasty was analyzed.Results In 32 keratoconus patients with acute edema,Descemet’s membrane(DM)detachment with a large hole was observed in 10 cases(31.250%),DM detachment with a small hole was observed in 15 cases(46.875%),and DM detachment was observed in 7 cases(21.875%).There were 32 patients who underwent keratoplasty,including 23 cases of penetrating keratoplasty and 9 cases of deep lamellar keratoplasty(including 5 cases using the large-bubble method and 4 cases using the hand-peeling method).Spearman correlation analysis showed that the deep lamellar keratoplasty was positively correlated with the absence of DM rupture(r=0.787,P<0.01).Conclusions The success rate of deep lamellar keratoplasty is high in keratoconus patients with simple DM detachment during acute corneal edema phase.AS-OCT can guide the choice of keratoplasty methods for keratoconus patients with healed acute corneal edema.