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穿透性角膜移植联合玻璃体切除术:长期随访结果

Combined Penetrating Keratoplasty and Vitrectomy: Long-Term Follow-Up Results.

作者信息

Vidne-Hay Orit, Alhalel Amir, Barequet Irina S

机构信息

Goldschleger Eye Institute, Sheba Medical Center, 5262000 Ramat Gan, Israel.

Faculty of Medical & Health Sciences, Tel Aviv University, 52621 Tel Aviv, Israel.

出版信息

J Clin Med. 2024 Dec 8;13(23):7468. doi: 10.3390/jcm13237468.

Abstract

: To assess the long-term outcomes of combined penetrating keratoplasty (PKP) and pars plana vitrectomy (PPV). : A retrospective review of eyes that underwent combined surgery followed for 12 months or longer. Demographic data, indications for surgery, and pre-/post-surgical eye examinations were retrieved. : Thirteen consecutive eyes (13 patients) were enrolled. The mean age was 51.5 ± 20.5 years, and the mean follow-up time was 67 ± 36.9 months. All cases had severe corneal opacity. Indications for surgery included retinal detachment (76.9%), dropped lens (7.7%), dropped intraocular lens (7.7%), and endophthalmitis with corneal abscess (7.7%). Visual acuity improved in 46.1% of the cases, though in most cases visual acuity remained low, and decreased in 23% of the cases. In 23% of the cases (3 eyes), ambulatory vision was achieved for more than 12 months and in 15.4% for three years. Silicone oil tamponade was used in all cases of retinal detachment (10 eyes). Of these eyes, at the final follow-up, four eyes were attached, two eyes were partially attached, and corneal opacity prevented retinal visualization in three eyes. One eye was eviscerated and one eye developed phthisis. Postoperatively, 61.5% of the cases underwent repeated PKP for graft decompensation. At the final visit, graft failure was observed in 75% of the cases. : The long-term follow-up of eyes that underwent combined PKP and PPV supports this technique in complex cases for eye and vision preservation. The main problem after combined surgery is the long-term survival of the corneal graft which may require repeated PKP surgeries. With this approach, in 23% of the cases, ambulatory vision was maintained for more than 12 months.

摘要

评估穿透性角膜移植术(PKP)联合玻璃体切除术(PPV)的长期疗效。

回顾性分析接受联合手术且随访12个月或更长时间的患者眼部情况。收集人口统计学数据、手术指征以及手术前后的眼部检查结果。

连续纳入13例患者(13只眼)。平均年龄为51.5±20.5岁,平均随访时间为67±36.9个月。所有病例均有严重角膜混浊。手术指征包括视网膜脱离(76.9%)、晶状体脱位(7.7%)、人工晶状体脱位(7.7%)以及伴有角膜脓肿的眼内炎(7.7%)。46.1%的病例视力有所改善,不过大多数病例视力仍较低,23%的病例视力下降。23%的病例(3只眼)实现了超过12个月的可移动视力,15.4%的病例实现了3年的可移动视力。所有视网膜脱离病例(10只眼)均使用了硅油填充。在这些眼中,末次随访时,4只眼视网膜复位,2只眼部分复位,3只眼因角膜混浊无法观察到视网膜情况。1只眼行眼内容剜除术,1只眼发生眼球痨。术后,61.5%的病例因植片失代偿接受了再次PKP。末次随访时,75%的病例观察到植片失败。

对接受PKP联合PPV的患者进行长期随访,支持该技术用于复杂眼部病例以保存眼球和视力。联合手术后的主要问题是角膜植片的长期存活,这可能需要重复进行PKP手术。采用这种方法,23%的病例维持了超过12个月的可移动视力。

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