非开天窗穿透性角膜移植联合白内障超声乳化及人工晶体植入术

Non-Open Sky Penetrating Keratoplasty Combined with Phacoemulsification and Intraocular Lens Implantation

目的:介绍一种新的非开天窗穿透性角膜移植联合白内障超声乳化及人工晶体植入的三联手术,并初步评价其临床效果及并发症。方法:前瞻性非对照临床研究,角膜病变合并白内障进行非开天窗穿透性角膜移植联合白内障超声乳化及人工晶体植入术17例(17只眼)。分析其手术原因,手术方法,术后视力,术后散光,角膜内皮细胞丢失,角膜排斥及其他并发症。结果:17例角膜病变合并白内障患者,其中男9例,女8例。年龄最小26岁,最大70岁,平均年龄55.35 ±11.66岁。其中Funchs角膜内皮营养不良合并白内障2例,角膜内皮失代偿合并白内障5例,角膜白斑合并白内障7例,单纯疱疹病毒性角膜炎合并白内障2例,角膜移植术后排斥合并白内障1例。所有患者由同一医师操作行非开天窗穿透性角膜移植联合白内障超声乳化及人工晶体植入术。随访时间最短7月,最长36月,平均随访时间17.47 ±8.11月。术前视力(BCVA)均为LP到数指/50 cm。术后视力(BCVA)中位数0.20 (范围:0.05~0.5)。术后散光中位数1.75D (范围:0.75D^4.25D)。术中1例后囊破裂发生,人工晶状体植入睫状沟(1例,5.9%),其余所有人工晶状体均植入囊袋(16例,94.1%)。术前角膜内皮细胞计数为2316.88 ±167.26 (cell/mm2);术后6月角膜内皮细胞计数为1607.82 ±228.45 (cell/mm2);内皮细胞丢失率为30.6%。在6~36月的随访中,15只眼术后角膜移植片透明,植片透明率88.2%。1例(5.9%)发生角膜移植排斥,1例(5.9%)发生角膜新生血管化。1例(5.9%)角膜上皮化延迟,经角膜绷带镜及自体血清治疗痊愈。未发生其他并发症。结论:非开天窗穿透性角膜移植联合白内障超声乳化及人工晶体植入术,是安全有效的新的三联手术方法,可以作为治疗角膜病变合并白内障的选择之一。掌握相关手术技巧,可以减少术中并发症。

Purpose: To introduce a innovative triple keratoplasty of non-open sky penetrating corneal transplantation combined with cataract phacoemulsification and intraocular lens implantation, and evaluate its clinical effect and complications. Methods: Prospective non-controlled clinical study. Non-open sky penetrating corneal transplantation combined with phacoemulsification and intraocular lens implantation was performed in 17 patients (17 eyes) with keratopathy complicated with cataract. The primary pathogenesis, surgical methods, postoperative vision, postoperative astigmatism, loss of corneal endothelial cells, corneal rejection and other complications were analyzed. Results: The average age of the 17 patients with keratopathy complicated with cataract patients was 55.35 ±11.66 years (range from 26 to 70 years), with 9 males and 8 females. Among them, Funchs corneal endothelium dystrophy complicated with cataract in 2 cases, corneal endothelium decompensation complicated with cataract in 5 cases, corneal leukoplakia com- plicated with cataract in 7 cases, herpes simplex keratitis complicated with cataract in 2 cases, and corneal graft failure complicated with cataract in 1 case. All operations were performed by the same physician. The average follow-up time was 17.47 ±8.11 months (range from 7 to 36 months). Preoperative visual acuity (BCVA) was LP to counting fingers/50 cm. The median postoperative visual acuity (BCVA) was 0.20 (range from 0.05 to 0.5). The Median astigmatism after surgery was 1.75D (range from 0.75D to 4.25D). Intraoperative posterior capsular rupture occurred in 1 case and the intraocular lens was implanted into the ciliary sulcus (1 case, 5.9%). All other intraocular lenses were implanted into the pouch (16 cases, 94.1%). The Endothelial cell loss rate was 30.6% (Corneal endothelial cell count preop/postop: 2316.88 ±167.26/1607.82 ±228.45 cell/mm2). During the follow-up period of 6-36 months, 15 eyes had clear corneal grafts and the graft transparency rate was 88.2%. Corneal graft rejection occurred in 1 case (5.9%) and neovasculari- zation occurred in 1 case (5.9%). One patient (5.9%) had delayed corneal epithelialization and was cured by corneal bandages and autologous serum. No other complications occurred. Conclusion: Non-open sky penetrating corneal transplantation combined with cataract phacoemulsification and intraocular lens implantation is a safe and effective innovative triple keratoplasty method. It can be used as one of the options for the treatment of keratopathy complicated with cataract. Relevant surgical skills can reduce intraoperative complications.