复杂性眼外伤的眼前段多联手术

目的 观察复杂性眼外伤眼球前段多种联合手术,以重建眼球前段结构的效果。方法 38例（38眼）复杂性眼外伤同时行穿透性角膜移植术、白内障及前段玻璃体切除、人工晶状体植入、虹膜缺损修复及瞳孔成形等联合手术,以恢复眼球前段正常结构,并观察其疗效。结果 术后随访6－67月,角膜植片透明者28例（73．68％）,视力恢复0．05以上者23例（60．53％）,瞳孔恢复接近圆形者24例（63．16％）。结论 复杂性眼外伤眼球前段多联手术,可减少术后并发症,提高角膜的透明率与视功能,缩短疗程。瞳孔成形还有利于减少畏光,改善外观。     

眼前段结构紊乱的二期后房型人工晶状体植入

目的 探讨重建眼前段结构,以机化膜为依托行二期后房型人工晶体状体植入手术的方法,并评价其疗效。方法 对不同程度眼前段结构紊乱８６只眼前眼前段结构重建及人工晶状体植入术。包括部分穿透性角膜移植术、前粘连松解术、虹膜根部离断缝合术、后粘连松解术、瞳孔成形术、瞳孔区机化膜造孔及以机化膜为依托的二期后房型人工晶状体植入术。随访３～３２个月。结果 ８６只眼手术顺利。术后视力≥０．５者７１只眼（８２．６％）,     

两种术式角膜移植治疗圆锥角膜疗效比较

目的 比较深板层角膜移植和穿透性角膜移植术治疗圆锥角膜的临床效果。方法 2001年1月～2004年6月共收治圆锥角膜连续病例65例76眼，其中行深板层角膜移植术（指植床仅保留角膜后弹力层和内皮层）43眼，穿透性角膜移植术33眼，术后随访8个月～3年，比较不同术式下视力、角膜内皮计数、并发症、角膜植片透明等情况。结果 43眼行深板层角膜移植术后，裸眼视力≥0．4的25眼，33眼行穿透角膜移植术后，裸眼视力≥0．4的18眼，两组矫正视力均≥0．4，二者差异无统计学意义（X^2=0．089，P〉0．05）。深板层角膜移植术后角膜内皮计数平均（2870±340）个／mm^2，而穿透性角膜移植术后角膜内皮计数平均（2120±290）个／mm^2，二者差异有统计学意义（t=10．15，P〈0．05），深板层角膜移植术并发症为植床小穿孔4眼，后弹力层皱褶3眼，层间薄翳3眼，散光（〉2D）18眼；穿透性角膜移植术的并发症主要为植片排斥3眼，虹膜局限性前粘连5眼，散光（〉2D）15眼。两种方式术后均未见圆锥角膜复发，所有植片均透明。结论 深板层角膜移植治疗圆锥角膜可获得与穿透角膜移植一样的视力效果，且并发症较少，但与后者相比有一定局限性。     

部分穿透性角膜移植术临床观察

目的　观察部分穿透性角膜移植术的疗效及并发症。方法　角膜病盲患者５１ 例５３ 眼行部分穿透性角膜移植术,术后随访０．３～７ａ。结果　角膜植片透明者５０ 眼（９４．３４％ ）,视力恢复０．０５ 以上者２５眼（９２．５９％ ,脱盲率）,０．３以上者１２眼（４４．４４％ ,脱残率）。　结论　部分穿透性角膜移植术可使角膜病盲患者复明。     

儿童穿透性角膜移植术

目的 探讨儿童穿透性角膜移植术的手术技巧及对植片透明率的影响因素。方法 采用穿透性角膜移植术对不同病因所致的儿童角膜混浊３０例（３３只眼）进行治疗，术后随访６个月至３年。结果 植片透明率为６６．７％，脱盲率为４４．８％，其中先天性角膜混浊治疗的疗效较差，植片失败的主要原因为内皮型免疫排斥反应。结论 儿童穿透性角膜移植术的效果较成人差，但从预防弱视和美容方面，积极争取早期手术是必要的。     

穿透性角膜移植术后白内障行超声乳化吸出和人工晶体植入手术

目的探讨穿透性角膜移植术后白内障行超声乳化吸出和人工晶体植入方法及疗效。方法应用超声乳化仪为22只眼穿透性角膜移植术后白内障行白内障吸出和人工晶体植入手术。术后观察视力、角膜内皮变化和角膜移植片透明度。结果视力：12只眼0．1～0．4（54．5％），8只眼0．5～0.9（364％），2只眼＜01（9．1％）；角膜内皮细胞平均损失率17．76％；术后角膜移植片全部透明。结论本方法治疗角膜移植术后白内障，其术后视力恢复快，角膜内皮细胞损失少，可维持角膜移植片的透明。     

穿透性角膜再移植的适应症和效果

回顾了中山眼科中心自１９８０年至１９９０年施行的８２例（８６眼）穿透性角膜再移植的情况。术后随访时间为６个月至１０年（平均３．２年）。再移植的８６眼中，最终有４９眼（５７％）植片透明，３７眼（４３％）植片混浊。具有透明植片的４９眼中，３２眼（８４．２％）视力比再移植前提高，１眼（２．６％）下降，５眼（１３．２％）保持原视力。这些结果表明，穿透性角膜移植仍有可能获得较好的增视效果和透明的植片。     

保留人工晶状体的穿透性角膜移植术

目的探讨人工晶状体眼行穿透性角膜移植术时,保留人工晶状体的方法。方法人工晶状体术后16例（16只眼）,合并有大泡性角膜病变11只眼,角膜白斑5只眼。采用角膜缘双针固定人工晶状体方法,再常规行穿透性角膜移植术,处理原人工晶状体并发症。结果16例（16只眼）保留人工晶状体,术中人工晶状体固定平稳,2只眼行人工晶状体位置调整,2只眼剪除人工晶状体前膜。术后随访6～18个月,平均（11．2±2．3）个月,矫正视力0．2—0．5者14只眼,占87．5％,角膜保持透明15只眼,占93．7％,所有术眼前房正常。结论人工晶状体眼行穿透性角膜移植时,双针固定人工晶状体,对保留原人工晶状体、处理原人工晶状体并发症、减少植片内皮细胞损失、保持植片透明、恢复视力,是一种简便易行的较好的辅助手术方法。     

环孢霉素A在高危角膜移植免疫排斥应用观察

目的：探讨环孢霉素A在高危角膜移植手术后防治角膜移植排斥反应的疗效。方法：对在我院施行穿透性及槔层角膜移植术中属于高危角膜移植的病共24例26只眼,其中≥9mm的大植片的有12只眼（占50％）,在术后26只眼均用环孢霉素A口服及环孢霉素A液滴眼。结果：角膜移植术后出现角膜排斥反应的有10例11只眼（占42．3％）,经过治疗后角膜植片均透明,术后角膜移植片最终透明者有24只眼（占92．3％）,未见严重副作用。结论：证明在高危角膜移植术应用环孢霉素A治疗角膜移排斥反应是确实有效。     

穿透性角膜移植聊合房水引流装置植入治疗严重角膜病变合并青光眼

目的：观察穿透性角膜移植聊合房水引流装置植入术治疗严重角膜病变合并离治性青光眼的临床效果和安全性。方法：1996年以来对13只严重角膜病变合并离治性青光眼的患眼一次施行穿透性角膜移植术和Ahmed青光眼阀植入术。术后随诊观察至少11个月,平均20个月,观察项目主要是角膜移植片的透明情况,房水引流装置的硅管有无阻塞,视力,眼压和并发症,结果：视力提高10只眼（76．9％）,眼压降至正常11只眼（84．6％）,角膜植片透明9只眼（69．2％）,房水引流管通畅12只眼（92．3％）,结论：穿透性角膜移植术同时联合房水引流装置植入术治疗严重角膜病变合并青光眼可达到满意的降眼压效果,改善角膜移植片的透明度,提高患的视功能。     

深低温长期保存角膜穿透性移植的临床分析

目的：分析深低温长期保存角膜穿透性移植术的临床效果和术后并发症。方法：用深低温保存1～60个月(平均5．5个月)的角膜行部分穿透性移植术25例(25只眼)。结果：随访1～36个月(平均15．6个月)，18例植片透明(72．0％)，5例半透明，1例混浊，另1例摘掉眼球。术后并发症有：角膜水肿(100％)、虹膜粘连(16．0％)、并发性白内障(16．0％)、角膜裂开(4．0％)、继发性青光眼(8．0％)、排斥反应(24．0％)、上皮持续缺损(8．0％)。结论：深低温长期保存角膜的穿透性移植术后并发症部分可能与深低温保存有关，但仍是角膜移植的重要储备来源，具有重要的临床价值。     

穿透性角膜移植治疗外伤性角膜病变的临床观察

目的:探讨穿透性角膜移植术治疗外伤性角膜病变的临床疗效。方法:对17例外伤性角膜病变施行穿透性角膜移植术,2例行穿透性角膜移植术联合小梁切除术,观察术后角膜植片及视力变化。结果:随访6~18(平均11.2)mo,术后临床症状明显缓解或消失,植片透明率为84%。视力较术前提高,其中矫正视力0.05以上16例;术后继发性青光眼5例,内皮型排斥反应4例。结论:穿透性角膜移植术是治疗外伤性角膜病变的一种有效的手术方式,其主要并发症为继发性青光眼和角膜移植排斥反应。     

Prognosis of keratoplasty in viral keratitis.

We reviewed 45 eyes with active or inactive herpetic keratitis that underwent penetrating keratoplasty. In Group I, 15 eyes underwent penetrating keratoplasty without prior optical iridectomy. In Group II, 15 eyes underwent penetrating keratoplasty after prior optical iridectomy. In Group III, 15 eyes underwent penetrating keratoplasty with pupilloplasty after prior optical iridectomy. Graft clarity of 3+ or more was obtained after one year in 67%, 33%, and 60% of eyes in Groups I, II, and III, respectively. Visual outcome of 6/24 or better was found in 53% of all eyes during the one-year follow-up. The occurrence of cataract both pre- and postoperatively could have been a result of prolonged use of corticosteroids and/or uveitis. Although there were several variables apart from preoperative vascularization and cataract, prior optical iridectomy was identified as a risk factor with regard to post-operative complications, final visual acuity, and graft clarity.     

角膜移植治疗角膜及眼表疾病98例临床分析

目的分析穿透性角膜移植及板层角膜移植治疗角膜疾病及眼表疾病的临床特点。方法回顾性研究穿透性角膜移植、板层角膜移植及板层角膜移植联合羊膜移植手术共98例（101眼）,观察术后视力、排斥反应、继发青光眼及原发病复发。随访6～24月,平均12．8月。结果穿透性角膜移植术79例（82眼）巾,62例（78．48％）术后视力较术前有提高,排斥反应11例（12眼）,原发病复发3例（3眼）,继发青光眼10例（10眼）。板层角膜移植术后视力无明显变化,排斥反应1例（1眼）,未见原发病复发及继发青光眼。结论角膜移植是治疗严重角膜疾病及眼表疾病有效手术方式,积极预防及治疗术后并发症可以提高角膜移植成功率。     

Iris reconstruction in penetrating keratoplasty--surgical techniques and a case-control study to evaluate effect on graft survival

PURPOSE: To demonstrate techniques of iris reconstruction (pupilloplasty) at the time of penetrating keratoplasty (PKP) for a variety of pupil abnormalities, and to evaluate the effect of pupilloplasty on graft survival and visual outcome. DESIGN: Case-control study. METHODS: Thirty-five cases (combined PKP and pupilloplasty) and 70 controls (PKP alone) were included. Various pupil abnormalities and the surgical techniques used to correct them were reviewed and categorized. The Chi-square and Student t tests were used to compare the baseline risk factors and demographic variables between treatment and control groups. The known risk factors for corneal graft survival were analyzed by Kaplan-Meier and Cox regression methods. RESULTS: Twenty men and 15 women in the age range, 27 to 77 years underwent combined iris reconstruction and PKP with pseudophakic/aphakic bullous keratopathy being the most common indication. The mean follow-up duration was 39.12 months and eight (22.9%) grafts failed during follow-up. Iris reconstruction during PKP has a significant positive effect on long-term graft survival (hazard ratio 2.52; 95% CI, 1.14 to 5.57; P = .022). Patients with pupilloplasty also tended to have a better mean postoperative visual acuity compared to the control group (P = .40). CONCLUSIONS: Iris reconstruction is a relatively simple procedure that should be performed in eyes with substantial pupil abnormalities at the time of PKP. Pupilloplasty significantly improves graft survival, renders the pupil cosmetically more acceptable, and may improve visual outcome.     

Outcomes of combined penetrating keratoplasty and cataract extraction compared with penetrating keratoplasty alone

PURPOSE: To compare the rejection rates, graft failure rates, mean visual, keratometric and refractive outcomes of combined penetrating keratoplasty and cataract extraction with penetrating keratoplasty alone. METHODS: A retrospective study of all patients who had combined keratoplasty and cataract extraction/intraocular lens insertion (49 eyes; mean age 65.3 years; mean follow up 17 months) compared with all patients who had keratoplasty only (58 eyes; mean age 64.0 years; mean follow up 14 months). RESULTS: One hundred and seven eyes in 99 patients had keratoplasty in the period and were included in the study. The most common indication for keratoplasty in patients who had triple procedures was Fuchs' endothelial dystrophy (24.5%). During the study seven (6.5%) grafts failed and four (3.7%) had allogenic rejection without failure during this period. There was no statistical difference between the graft survival rates of the two study groups. The mean postoperative logMAR visual acuity (VA) was 0.42 and postoperative VA of 6/12 or better was seen in 71% of patients. Mean postoperative corneal curvature was 44.6 dioptres (D), mean corneal astigmatism was -4.0 D and was >or=5 D in 38%. Mean double-angle Cartesian coordinates for corneal astigmatism were x-0.87 D and y-0.29 D. Mean best sphere of postoperative refractions was -0.61 D and mean absolute refractive error was 2.2 D. There was no statistically significant difference in VA, keratometric or refractive outcome measures between the two study groups. CONCLUSION: Over a short follow up, keratoplasty combined with cataract extraction/intraocular lens insertion showed a similar risk of graft failure or allogenic graft rejection when compared with keratoplasty alone and we recommend the triple procedure for quicker visual recovery and less operative procedures.     

应用临时人工角膜行前后节联合手术治疗严重眼外伤

目的 比较应用临时人工角膜行玻璃体切割联合穿透性角膜移植术治疗不同类型严重眼外伤的临床效果.方法 对伴有严重角膜混浊的眼外伤患者20例(21只眼),包括爆炸伤11例(12只眼)、眼球穿通伤9例(9只眼).术前视力为光感～眼前手动,采用临时人工角膜代替病变角膜完成闭合式玻璃体切割、白内障切除、球内异物取出、视网膜复位等眼内操作后,再用新鲜供体角膜置换人工角膜.术后随访3～36个月,平均17月,随访视力、眼压、眼球解剖完整性及并发症.结果 全部眼爆炸伤和78%的眼球穿通伤,共19只眼(90%)保存眼球解剖结构完整性.11只眼(52%)保持最佳矫正视力≥0.05,其中眼爆炸伤9只眼(9/12),穿通伤2只眼(2/9).严重影响预后的并发症有持续性低眼压、复发性视网膜脱离,均发生在眼穿通伤.结论 临时人工角膜下行前后节联合手术是治疗伴有严重角膜混浊的外伤眼的惟一有效的方法,眼爆炸伤预后好于眼球穿通伤.     

穿透性角膜移植聯合房水引流裝置植入治瘵嚴重角膜病變合并青光眼

目的觀察穿透性角膜移植聯合房水引流裝置植入術治瘵嚴重角膜病變合并難治性青光眼的臨床效果和安全性.方法1996年以來對13衹嚴重角膜病燮合并難治性青光眼的患眼一次施行穿透性角膜移植術和Ahmed青光眼閥植入術.術後随診觀察至少11個月,平均20個月.觀察項目主要是角膜移植片的透明情况、房水引流裝置的硅管有無阻塞、視力、眼壓和并發癥.結果視力提高者10衹眼(76.9%),眼壓降至正常者11衹眼(84.6%),角膜植片透明者9衹眼(69.2%),房水引流管通暢者12衹眼(92.3%).結論穿透性角膜移植術同時聯合房水引流裝置植入術治瘵嚴重角膜病燮合并青光眼可達到滿意的降眼壓效果,改善角膜移植片的透明度,提高患者的視功能.     

Penetrating keratoplasty for silicone oil keratopathy

Purpose : Penetrating keratoplasty for silicone oil keratopathy is associated with high risks and limited visual prognosis. This study examined the outcomes and factors influencing graft failure. Methods : A retrospective, non‐comparative, interventional case series of patients attending Moorfields Eye Hospital, London. Results : A total of 24 penetrating keratoplasties were performed in 17 patients (13 men and four women) from 1991 to 2000. The mean age of patients undergoing surgery was 43.6 years (range 17–84 years, SD ± 21.0). Silicone oil was removed before or during the time of initial penetrating keratoplasty in nine patients (52.9%) and left in situ in eight patients (47.1%). Ten out of 24 grafts survived (41.7%). The median duration of graft survival was 21 months (range 2 weeks–98 months) with median duration of follow up 33 months (range 2–100 months). At final follow up, the number of patients with a clear graft who had oil removed before or during the time of penetrating keratoplasty was seven out of 10 (70.0%). Risk factors for graft failure included hypotony, multiple keratoplasty, corneal neovascularization, rejection episode, silicone oil left in situ and postoperative glaucoma. Conclusions : Management of these complex patients requires a combined approach from anterior segment and vitreoretinal subspecialties. The long‐term success of the graft can be improved if silicone oil is removed prior or during the time of penetrating keratoplasty.     

角膜移植术后行白内障摘出人工晶状体植入对角膜植片的影响

目的探讨穿透性角膜移植术后白内障行白内障摘出联合人工晶状体植入术对角膜植片的影响。方法穿透性角膜移植术6个月后行白内障摘出联合人工晶状体植入术17例（17眼）,随访3～18个月,平均11个月,观察术后角膜水肿情况、角膜内皮细胞计数变化、眼压变化、免疫排斥反应和术后并发症,并进行分析。结果术后所有患眼裸眼视力≥0．3,最佳矫正视力≥0．5者8眼。术后角膜水肿3～7d内消退,角膜恢复透明。术前角膜内皮计数平均为（1547±111）个／mm2。术后3月内皮细胞数量稳定,平均为（1275±106）个／mm2,内皮细胞丧失率平均为4．92％。无其它不良反应。结论对穿透性角膜移植术后行白内障摘出联合人工晶状体植入术对角膜植片是安全的。