穿透性角膜移植联合角膜缘移植治疗重度角膜烧伤

Shi Wei-yun, Gao Hua, Wang Fu-hua, Jin Xiu-ming, Xie Li-xin

Shangdong Eye Institute, Qingdao Eye Hospital, Qingdao 266071, China.

Zhonghua Yan Ke Za Zhi. 2005 May;41(5):394-8.

OBJECTIVE

To study the clinical results of combined penetrating keratoplasty with keratolimbal allograft transplantation in the treatment of severe corneal burns.

METHODS

The present study consisted of 35 eyes (34 patients) with full thickness corneal opacities and extensive corneal conjunctivalization after severe corneal burns. The duration between the injury and the time of presentation ranged from four months to 23 years. Group A: Combined penetrating keratoplasty (PK) with annular keratolimbal allograft transplantation (KLAT) was performed in 19 eyes (18 patients). Group B: Total PK with a scleral rim was performed in 16 eyes (16 patients). Post-operative visual acuity, intraocular pressure, graft rejection and complications were monitored. The average follow up time was 24 (range from 15 to 28) months.

RESULTS

(1) Vision: The number of eyes that obtained best corrected visual acuity > 0.05 was 18 eyes (95%) in group A and 14 eyes (84%) in group B at 6 months postoperatively (P = 0.582); 16 eyes (88%) in group A and 6 eyes (38%) in group B at 12 months (P = 0.006); 12 eyes (63%) in group A and 3 (7%) in group B at 24 months (P = 0.016). (2) Graft rejection: Nine allografts (47%) in group A and 8 grafts (50%) in group B developed limbal stem cell rejection (P = 1.000); 6 allografts (32%) in group A and 11 allografts (69%) in group B developed endothelium rejection (P = 0.044). The difference of endothelium rejection rate between group A and B was not significant at different times postoperatively. (3)COMPLICATIONS: Corneal epithelium defect occurred in 2 eyes (11%) in group A and 7 (44%) eyes in group B (P = 0.049); hyphema occurred in 2 eyes (11%) in group A and 8 eyes (50%) in group B (P = 0.022); hypotony occurred in 1 eye (5%) in group A and 6 eyes (38%) in group B (P = 0.032).

CONCLUSIONS

PK combined with KLAT is an effective treatment for severe corneal burns at a late stage irrespective of the etiology. This procedure can restore visual function in severely damaged eyes. Patients treated with PK combined with KLAT show less complication and better prognosis as compared with patients treated with total PK with a scleral rim.

目的

研究穿透性角膜移植联合角膜缘移植治疗严重角膜烧伤的临床效果。

方法

本研究纳入35眼（34例患者），均为严重角膜烧伤后全层角膜混浊且伴有广泛角膜结膜化。受伤至就诊时间为4个月至23年。A组：19眼（18例患者）行穿透性角膜移植（PK）联合环形角膜缘移植（KLAT）。B组：16眼（16例患者）行带巩膜环的全层PK。术后监测视力、眼压、移植排斥反应及并发症。平均随访时间为24（15至28）个月。

结果

（1）视力：术后6个月时，A组最佳矫正视力>0.05的眼数为18眼（95%），B组为14眼（84%）（P = 0.582）；术后12个月时，A组为16眼（88%），B组为6眼（38%）（P = 0.006）；术后24个月时，A组为12眼（63%），B组为3眼（7%）（P = 0.016）。（2）移植排斥反应：A组9例移植片（47%）和B组8例移植片（50%）发生角膜缘干细胞排斥反应（P = 1.000）；A组6例移植片（32%）和B组11例移植片（69%）发生内皮排斥反应（P = 0.044）。A组和B组内皮排斥反应率在术后不同时间差异无统计学意义。（3）并发症：A组2眼（11%）发生角膜上皮缺损，B组7眼（44%）发生角膜上皮缺损（P = 0.049）；A组2眼（11%）发生前房积血，B组8眼（50%）发生前房积血（P = 0.022）；A组1眼（5%）发生低眼压，B组6眼（38%）发生低眼压（P = 0.032）。