穿透性角膜移植术治疗坏死性基质角膜炎23例

Penetrating keratoplasty in treatment of 23 cases with necrotizing stromal keratitis

目的:探讨穿透性角膜移植术(penetratingkeratoplasty,PKP)治疗坏死性基质角膜炎(necrotizingstromalkeratitis)的手术适应证及其临床效果。方法:按照Holland等的HSK新分类法,选择确诊坏死性基质角膜炎患者,予以局部及全身药物治疗。对病情不能控制,药物治疗无效的患者22例(23眼),其中角膜溶解穿孔3眼,用新鲜角膜组织行穿透性角膜移植术,并随访观察术后疗效。结果:随访3mo～3a,22例(23眼)中,术后视力提高者18眼,其中矫正视力达到0.1～0.5者12眼,0.05～0.1者6眼;无改善者5眼。角膜植片透明17眼,半透明2眼,植片混浊4眼,植片透明率为74%。术后3眼植片发生排斥反应,3眼原发病灶复发。2眼术后因排斥反应及原发病灶反复发作,植片完全混浊,行2次角膜移植术。结论:对坏死性基质角膜炎患者,药物保守治疗无效、角膜坏死穿孔或行将穿孔,及时用新鲜角膜组织行穿透性角膜移植术治疗,不仅能控制炎症,缩短病程,而且能保存眼球,恢复部分视力,因此具有重要临床应用价值。

AIM: to explore the operative indication and effect of penetrating keratoplasty (PKP) in treating necrotizing stromal keratitis.· METHODS: Patients diagnosed as necrotizing stromal keratitis were chosen according to Holland's new HSK classification and underwent local or systemic treatment. For the 22 cases (23 eyes) in which medicine was noneffective (cornea dissolution and penetration occurred in 3 eyes), PKP was performed with fresh cornea implants and the postoperative effect was followed up.· RESULTS: During the follow-up of 3mo-3a, visual acuity improved in 18 eyes, among which the corrected visual acuity reached to 0.1-0.5 in 12 eyes and 0.05-0.1 in 6 eyes; it remained noncorrected in 5 eyes. The cornea implants were transparent in 17 eyes, semi-transparent in 2 eyes and cloudy in 4 eyes, with the transparent rate of 74%. Cornea exclusion occurred in 3 eyes, and primary diseases recurred in 3 eyes. The implants became completely cloudy due to cornea exclusion as well as primary disease recurrence and thus required second keratoplasty in 2 eyes.· CONCLUSION: For cases of necrotizing stromal keratitis in which medicine proved to be noneffective and cornea necrosis or perforation occurred, PKP should be performed properly with fresh cornea implants, which can manage inflammation, shorten the course of disease, save eyeballs and partially restore visual acuity. Thus this method is of great clinical value. ·