角膜移植术后免疫排斥反应的探讨

A clinical evaluation of immunological rejection following corneal transplantation

目的 为有效控制角膜移植术后免疫排斥反应的发生 ,探讨角膜移植术后免疫排斥反应发生的因素。方法 对角膜移植手术术后发生排斥反应者进行分析 ,总结发生的原因、时间、程度等。结果 12 3眼中发生免疫排斥反应者 46眼(3 7 4% ) ,其中 17眼发生不可逆的排斥反应 ,占排斥反应的 3 6.96% ;有角膜新生血管者发生排斥反应 41眼 ,占 89 13 %。内皮型排斥反应 2 0眼 ,上皮型 12眼 ,基质型 3眼 ,混合型 11眼。排斥反应发生时间为术后 3周～ 3年 ,术后 3～ 6月发生率最高 ,占 46.48%。结论 免疫排斥反应的发生是多因素参与的复杂过程 ,与角膜新生血管的数量、角膜受损及感染的程度、植片的大小。

Objective To evaluate the correlative factors of immunological rejection follwing corneal transplantation for controlling the immunological rejection.Methods In 123 eyes were performed on corneal transplantation, immunological rejection emerged in 46 eyes,the reason,time and degree was summarized.Results The incidence of immunological rejection was 37.40% and 89.13% due to corneal angiogenesis.The inreversible immunological rejection was 36.96%(17/46).The immunological rejection involved endothelial type(20 eyes,43 48%),epithelial type (12 eyes,26.09%),stromal type (3 eyes,6.52%),mixed type (11 eyes, 23.91%).Postoperatively,the immunological rejection generally took place from 3 weeks to 3 years.Nearly 46.86% eyes occurred from 3 to 6 months after operation.Conclusion The immunological rejection is very complicated courses for various reasons,it is correlated to the quantity of corneal angiogenesis,the degree of corneal trauma and infectionm,the size of graft,the frequency combined occasion and pattern of operation.