穿透性角膜移植432例流行病学报告

目的调查报告穿透性角膜移植（ｐｅｎｅｔｒａｔｉｎｇｋｅｒａｔｏｐｌａｓｔｙ，ＰＫ）病人流行病学状况。方法根据ＰＫ适应证标准选择４３２例病人手术治疗，并行回顾性分析。分析ＰＫ病人流行病学状况。结果目前ＰＫ术适应证仍以感染性角膜病为主，约占６３．４％，其中病毒性角膜病约占４０．５％。年龄分布以中年组为主。职业以工人、农民等体力劳动者为主。结论ＰＫ术是治疗角膜疾病的一种有效手术方法。各种疾病的手术时机及手术方式值得进一步探讨，以期达到最佳治疗效果。     

角膜移植254例流行病学分析

目的调查分析近期东北地区角膜移植患者的致病原因。方法选择符合角膜移植手术适应症标准并行穿透或板层角膜移植的254例病例，分析角膜移植病人的致病原因结果日前角膜移植术适应症主要以各种原因导致的角膜白斑71例居首位，约占28．0％，其中病毒性角膜病导致的角膜白斑29例，约占40．8％。年龄分布以中青年组为主。结论角膜白斑是东北地区角膜移植的主要病因，其中真菌性逐年增多，病毒性逐年减少，但病毒性角膜病导致的角蟆白斑居多，预防角膜白斑的形成，可有效地降低临床角膜移植率。     

角膜移植243例流行病学分析

目的:调查分析角膜移植患者的流行病学状况。方法:收集分析我院近3a施行的243例穿透或板层角膜移植患者资料,回顾性分析角膜移植患者的流行病学状况。结果:目前我院角膜移植适应证以各种原因导致的感染性角膜溃疡为主,约占50%以上。年龄分布以中青年为主,职业以农民、工人为主。结论:角膜移植术目前仍是治疗角膜盲最常用和最有效的方法,及时有效的治疗感染性角膜溃疡,可以有效地降低角膜移植率。     

干燥法长期保存角膜片板层治疗性角膜移植1267例临床研究

目的：评价干燥脱水法长期保存角膜片在板层治疗性角膜移植术中的效果。方法：保存角膜片选自我院眼库干燥保存符合临床标准、复水透明的完整角膜片，临床病例选自我院角膜病组1976年8月—1999年12月期间行板层治疗性角膜移植患者1267例，从手术前后视力比较、原发病灶控制、植片存活情况进行临床效果综合分析。结果：保存角膜片复水透明合格率为94．9％，临床治愈率：感染性角膜溃疡／穿孔88．8％，血管属性全角膜白斑98．3％，化学及热烧伤(穿孔，睑球角粘连等)92．1％，圆锥角膜及急性圆锥角膜99.5％，角膜变性(边缘性及前基质层)99.0％，其他88．9％，平均总治愈率：93．5％。结论：1．对各种严重的角膜感染、药物治疗无法控制的病人，治疗性角膜移植术是唯一有效的方法。2．采用无水氯化钙——硅胶干燥脱水长期保存的供体角膜能为临床随时提供角膜材料，是一项简单易行、便于推广应用的成功率很高的保存方法。眼科学报2003；19：110-113     

干燥法长期保存角膜板层移植1267例临床研究

目的：评价干燥脱水法长期保存角膜片在板层治疗性角膜移植术中的效果。方法：保存角膜片选自我院眼库干燥保存符合临床标准、复水透明的完整角膜片，临床病例选自我院角膜病组1976年8月～1999年12月期间行板层治疗性角膜移植患者1267例，从手术前后视力比较、原发病灶控制、植片存活情况进行临床效果综合分析。结果：保存角膜片复水透明合格率为94．9％，临床治愈率：感染性角膜溃疡／穿孔88．8％，血管翳性全角膜白斑98．3％。化学及热烧伤(穿孔，睑球角粘连等)92．1％，圆锥角膜及急性圆锥角膜99．5％，角膜变性(边缘性及前基质层)99．0％。其他88．9％，平均总治愈率93．5％。结论：1．对各种严重的角膜感染、药物治疗无法控制的病人，治疗性角膜移植术是唯一有效的方法。2．采用无水氯化钙一硅胶干燥脱水长期保存的供体角膜能为临床随时提供角膜材料，是一项简单易行、便于推广应用的成功率很高的保存方法。     

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。     

272例施行穿透性角膜移植术原因的调查分析

目的探讨施行穿透性角膜移植术（PKP）的原因及其变化趋势。方法选择符合穿透性角膜移植手术适应症标准并行穿透角膜移植术的272例病例,分析行角膜移植患者的致病原因及变化趋势。结果角膜移植术病因以角膜白斑占首位（44．12％）,其余依次为感染性角膜炎（约20．59％）,角膜化学伤及热烧伤（约8．82％）、遗传相关的角膜营养不良和角膜变性、圆锥角膜、大泡性角膜病变、角膜破裂伤、再次角膜移植术者及其他。在调查期内,角膜白斑始终占角膜移植病因首位,数量和比重没有明显变化,感染性角膜炎和角膜化学伤及热烧伤的数量和比重在下降,圆锥角膜、大泡性角膜病变患者数量在逐步增加。其余病因变化不明显。形成角膜白斑的首要病因是真菌性角膜疾病（约46．28％）。真菌感染患者一直居感染性角膜炎病因首位,但绝对数量在下降,而所占比重在上升。年龄分布以中青年组为主。结论角膜白斑是穿透性角膜移植的主要病因,真菌性角膜疾病是导致角膜白斑的主要原因,并呈上升趋势。圆锥角膜和大泡性角膜病变在逐年增多。     

角膜缘移植联合穿透性角膜移植的临床观察

评价角膜缘移植联合穿透性角膜移植的效果。方法：９例行角膜缘移植的同时穿透性角膜移植术，术后随访３－７个月结果。植入透明率为８８．８９％，视力均有明显提高。结论角膜缘移植联合穿透性角膜移植一次性手术可明显植片的预后及视功能，是重角膜表面的一种合理的治疗方法。     

板层和穿透性联合角膜移植术的临床观察

目的：回顾性研究板层和穿透性联合角膜移植术治疗角膜病的效果。方法：对12例全角膜病变实施板层和部分穿透性联合角膜移植。手术将板层角膜巩膜病变切除，作中央部分穿透的植床，取新鲜尸体眼球，制作相应的角膜植片，植片与植床对应间断缝合。术后跟踪随访。结果：12例角膜植片术后均保持或恢复透明，裸眼视力0．1～0．2者4例，0．2以上者8例。术后免疫排斥反应被控制，没有虹膜前粘连和继发性青光眼并发症出现。结论：板层和部分穿透性联合角膜移植术，对大范围严重的角膜病变有较好的治疗效果，能治愈常规方法难以治愈的患者。     

200例穿透性角膜移植临床研究

目的：观察穿透性角膜移植的疗效和并发症。方法：对200例（200眼）穿透性角膜移植进行回顾性总结。结果：统计分析表明：角膜植片透明者180例（90.0%）视力≤0.04者73例（36.5%）,0.05～0.2者91例（45.5%）≥0.3者36例（18.0%）。主要并发症：角膜植片免疫排斥反应22例（11.0%）,继发性青光眼7例（3.5%）。结论：穿透性角膜移植可使角膜盲患者复明,但防治术后免疫排斥反应是成功关键。     

Applications for the femtosecond laser in corneal surgery

PURPOSE OF REVIEW: Little has changed in how corneal surgery, particularly full-thickness penetrating keratoplasty, has been performed since the introduction of the operating microscope and microsurgery more than 40 years ago. The introduction of IntraLase Enabled Keratoplasty represents the first true advancement in corneal surgery in that time. There are numerous studies that have documented the high degree of complications seen in procedures such as penetrating keratoplasty. The advent of IntraLase Enabled Keratoplasty affords an opportunity to improve the safety and effectiveness of such procedures. RECENT FINDINGS: Complications and visual outcomes remain an ongoing concern when it comes to managing patients following corneal surgery. The intensive postoperative follow up represents a significant undertaking for clinicians, staff and patients. Initial studies indicate that the use of the femtosecond laser in corneal surgery can simplify surgery, improve wound healing and lower levels of induced astigmatism. SUMMARY: This review will examine the uses of the femtosecond laser in corneal surgery, as well as early results that have been reported.     

Therapeutic keratoplasty for corneal perforation: clinical results and complications

PURPOSE: To report the clinical results, postoperative progress, and complications after therapeutic keratoplasty for corneal perforation. METHODS: Twenty consecutive eyes (20 patients) that underwent therapeutic keratoplasty between December 2003 and May 2006 were included. The eyes were evaluated retrospectively for the cause of the corneal perforation, the type of surgical technique and intraoperative complications, anatomic cure rates, graft clarity, visual prognosis, and postoperative complications. RESULTS: The causes of corneal perforation were herpetic keratitis (n = 5), bacterial ulcer (n = 1), fungal ulcer (n = 1), neurotrophic ulcer (n = 3), rheumatoid arthritis (n = 2), Mooren ulcer (n = 2), Terrien marginal corneal degeneration (n = 1), keratoconus (n = 1), and Wegener granulomatosis (n = 1). In 3 cases, the etiology was unknown. Six cases had a previous history of corneal transplantation. Anatomic cures were obtained in 16 (80%) of 20 eyes after the first transplantation procedure. Visual acuity (VA) equal to or better than the preoperative level was achieved in 17 (85%) of 20 eyes. The graft transparency rate was 67% in 15 eyes that underwent central penetrating keratoplasty with fresh donor tissue. Major postoperative complications included cataract (n = 6), glaucoma (n = 4), and recurrent disease (n = 3). CONCLUSIONS: Keratoplasty is valuable for maintaining the ocular integrity and VA. In cases with severe preoperative inflammation of the anterior segment, it is difficult to achieve transparency after the first graft.     

Indications for corneal transplantation in New Zealand: 1991-1999

PURPOSE: To identify the indications for keratoplasty in patients supplied with donor tissue through the New Zealand National Eye Bank. METHODS: Analysis of penetrating and lamellar keratoplasty data collected by the New Zealand National Eye Bank, Auckland, from 1991 to 1999. RESULTS: In this 9-year period, donor material was supplied for 1370 corneal grafts; 1308 for penetrating keratoplasty, 26 for lamellar keratoplasty, and 36 for unspecified grafts. This accounts for a minimum of 85% of the penetrating keratoplasties performed in New Zealand from 1991 to 1999. The leading indications for penetrating keratoplasty were keratoconus (45.6%), pseudophakic or aphakic corneal edema (17.9%), regraft (8.7%), viral keratitis (7.3%), and trauma (5.5%). The average age of patients was 47.5 years (SD = 22.6) and age distribution was bimodal, with peaks in the 3rd and 8th decades. Keratoconus, regraft, and trauma were significantly more common as indicators for penetrating keratoplasty in male patients than female patients; however, pseudophakic or aphakic corneal edema was more common in female patients. CONCLUSION: The majority of transplantation surgery in New Zealand is performed using corneal tissue from the New Zealand National Eye Bank. In this representative study, keratoconus is the leading indicator for penetrating keratoplasty in New Zealand, accounting for a higher proportion than in any other published literature. The other indications, age distribution and gender differences correlate with previous reports. These findings suggest that keratoconus leading to transplantation may have increased prevalence in New Zealand.     

Preliminary Report of Los Alamos Keratoplasty Techniques

We have found that intrastromal diathermy heat to the cornea spares the epithelium and endothelium, while preferentially allowing contraction of the midstromal corneal collagen. Extensive animal studies have demonstrated a potentially useful dosage range for primate corneal diathermy. We have initiated cautious preliminary human studies utilizing the Los Alamos Keratoplasty unit in the last 12 months to reshape the corneas of keratoconus patients who were referred for penetrating keratoplasty. The steepest area of the cone may be flattened from 4 to 57 diopters, thereby allowing a return to contact lens use. We recommend the technique of Los Alamos Keratoplasty as an alternative to penetrating keratoplasty in patients who have been successful in contact lens wear, but whose cone progression precludes continued satisfactory fitting. The procedure appears effective in this preliminary study. The eventual safety and long-term efficacy of this experimental keratorefractive surgical technique requires extensive further study.     

Systemic sensitization of corneal allograft recipients before the clinical onset of graft reaction.

We wished to know if full-thickness corneal allografts placed centrally in clear host corneas would cause systemic sensitization. Keratoplasty was done in 13 rabbits and a leucocyte migration inhibition test was done on their systemic blood five to seven days operation using donor specific corneal antigen. All but two animals had positive results (mean inhibition 27% "/- 2.2) showing that, following keratoplasty, systemic sensitization does occur. Absence of blood vessels and lymphatics thus does not constitute an absolute barrier to sensitization of the recipient.     

Cataract surgery with implantation of toric silicone lenses for severe astigmatism after keratoplasty

BACKGROUND: The treatment of high astigmatism after keratoplasty is often not possible with glasses or refractive corneal surgery, particularly in patients with anisometropia and contact lens incompatibility. METHODS: In 3 patients with cataract and high astigmatism after penetrating keratoplasty, phacoemulsification was performed via a 4 mm sclerocorneal tunnel incision. A toric silicone lens with Z-haptic was implanted in the bag (Type MS 6116 TU, Dr. Schmidt). All patients had high anisometropia and contact lens incompatibility. The follow-up was ten weeks, uncorrected and corrected visual acuity, corneal and total astigmatism were evaluated. RESULTS: A 68-year-old female presented with corneal astigmatism of 10 dpt. Keratoplasty was performed two years earlier. After implantation of a toric lens (+ 22.5 + 11.0 dpt.) uncorrected visual acuity increased from 1/50 to 20/40, corrected visual acuity increased from 20/30 to 20/25. A 78-year-old male presented with irregular corneal astigmatism of 6.5 dpt. Keratoplasty was performed 25 years previously. Due to high myopia (corneal radii 5.3/5.9 mm), implantation of a toric lens (- 3.0 + 7.0 dpt.) in the bag was combined with implantation of a spheric lens (- 6.0 dpt., Type MS 614, Dr. Schmidt) in the sulcus. Uncorrected visual acuity increased from light perception to 1/20, corrected visual acuity increased to 1/10. An 84-year-old female presented with irregular corneal astigmatism of 8.6 dpt. Keratoplasty was performed two years earlier. After implantation of a toric lens (+ 16.0 + 11.0 dpt.) uncorrected visual acuity increased to 20/50, corrected visual acuity increased from 20/100 to 20/25. During the follow-up all implanted lenses were well-centered and no significant IOL rotation was observed. CONCLUSION: Implantation of foldable toric silicone lenses during cataract surgery may improve considerably the uncorrected visual acuity by reducing the total astigmatism in patients with high astigmatism after keratoplasty. Preoperatively, a reliable keratometry is important.     

穿透性角膜移植150例的临床研究

目的：探讨穿透性角膜移植的主要病因、疗效及并发症。 方法：回顾性分析2011-01/2013-06于我院行穿透性角膜移植术的患者150例150眼。 结果：病因：角膜白斑99眼（66%）,角膜变性18眼（12%）,角膜溃疡15眼（10%）,角膜内皮失代偿10眼（6.7%）,圆锥角膜8眼（5.3%）。疗效：植片透明110例（73.3%）。视力≤0.05者42例（28%）,0.05〈视力≤0.3者60例（40%）,视力〉0.3者48例（32%）。并发症：主要并发症为免疫排斥反应28例（18.7%）。 结论：穿透性角膜移植是治疗角膜疾病致盲的重要有效手段,但术后排斥反应仍是影响手术成功的主要因素。