穿透性角膜移植术临床分析

目的 探讨穿透性角膜移植的主要病因、疗效和并发症.方法 对96例(97只眼)穿透性角膜移植进行回顾性研究,随访0.5～5年.结果 (1)病因:角膜白斑41只眼(42.3%),单纯疱疹病毒性角膜炎28只眼(28.9%),角膜溃疡16只眼(16.7%),圆锥角膜4只限(4.1%),大泡性角膜病变8只眼(8.2%).(2)疗效:角膜植片透明81只眼(83.5%),视力0.05以下7只眼(7.2%),0.05～0.2者53只眼(54.6%),0.3～0.5者28只眼(28.9%),0.5以上者9只眼(9.3%).(3)并发症:主要为角膜免疫排斥反应(8只眼)和继发性青光眼(4只眼).结论 穿透性角膜移植术是治疗角膜致盲性眼病的有效方法.     

角膜移植适应症的变化

自1965—1985.6中山眼科中心眼科医院共对3162眼施行角膜移植。最常见的角膜移植的适应症依次排列是:单纯疱疹角膜炎(活动期与静止期),细菌或真菌性角膜溃疡(炎症期或疤痕期),化学伤与热烧伤和蚕蚀性角膜溃疡,以上共占角膜移植总数的85.9%。比较少的是外伤性角膜白斑、角膜营养不良与变性。大泡性角膜病变、圆锥角膜等极为少见。从1965年至1974年,在穿透性角膜移植的病例中,细菌或真菌角膜溃疡(炎症期或疤痕期)占45.3%-68.4%;自1975年以后,其所占比例明显下降,至最近五年只占26%。与此相反,单纯疱疹角膜炎所占比例则逐年上升,至1976年以后,占穿透性角膜移植病例的45.1%-45.5%。1979年前,板层角膜移植术式较常用,近五年施用板层角膜移植的病人减少,而施行穿透移植的病人增加到70%。板层角膜移植主要用于治疗或为穿透性角膜移植作准备。所以在板层移植的适应症中,蚕蚀性溃疡占首位,化学烧伤居第二,感染性的慢性角膜溃疡或后遗的角膜疤痕占第三位。1979年以前,植片的直径以5.5-6.6 mm 居多,自1980年后,较多采用7-8mm,占50.8%。本文还简述了我院用板层角膜移植治疗蚕蚀性角膜溃疡的治愈率和体会。     

2006年至2015年角膜移植手术适应症及手术方式变化趋势的研究

目的探讨角膜移植手术适应症及手术方式的变化趋势。方法选取2006年1月至2015年12月于厦门大学附属厦门眼科中心行角膜移植手术的患者2476只眼的临床资料。对患者的性别、年龄、手术适应症及手术方式等数据进行统计分析。根据国内外学者的调查结果,将角膜移植手术适应症分为感染性角膜炎、眼外伤、大泡性角膜病变、再次角膜移植、圆锥角膜、角膜肿瘤、角膜变性或营养不良、蚕蚀性角膜溃疡及其他角膜病变等九种类型。手术方式分为穿透性角膜移植和板层角膜移植两类。根据移植替换部位的不同,将板层角膜移植进一步分为前板层角膜移植和内皮移植。结果在2476只眼角膜移植手术中,感染性角膜炎1067只眼,占总眼数的43.09%;眼外伤446只眼,占总眼数的18.01%;大泡性角膜病变201只眼,占总眼数的8.12%;再次角膜移植183只眼,占总眼数的7.39%;圆锥角膜140只眼,占总眼数的5.65%;角膜变性及营养不良124只眼,占总眼数的5.01%;角膜肿瘤123只眼,占总眼数的4.97%;蚕蚀性角膜溃疡101只眼,占总眼数的4.08%;其他角膜病变91只眼,占总眼数的3.67%。单纯疱疹病毒性角膜炎535只眼,占感染性角膜炎总眼数的50.14%;真菌性角膜炎261只眼,约占24.46%;细菌性角膜炎258只眼,约占24.18%;阿米巴病毒性角膜炎13只眼,约占1.21%。穿透性角膜移植1479只眼,占总眼数的59.73%;前板层角膜移植935只眼,占总眼数的37.76%;内皮移植62只眼,占总眼数的2.50%。结论感染性角膜炎在角膜移植中最为常见,其次为眼外伤和大泡性角膜病变。单纯疱疹病毒性角膜炎在感染性角膜炎中最为常见。穿透性角膜移植是进行角膜移植最常用的手术方式,前板层角膜移植的临床应用比例逐年升高,内皮移植呈现平稳发展趋势。     

板层角膜移植术治疗角膜病变

目的 探讨板层角膜移植术治疗角膜病变的疗效.方法 对16例(16眼)真菌性角膜溃疡、4例(4眼)角膜皮样瘤、3例(3眼)圆锥角膜患者行板层角膜移植术.结果 除2例(2眼)真菌性角膜溃疡术后复发改行部分穿透性角膜移植外,其余21例(21眼)手术均获成功.随访2个月～7a,21例植片均存活,角膜透明.14例(14眼)真菌性角膜溃疡患者矫正视力0.1～0.6;4例(4眼)角膜皮样瘤患者中2例层间出现少量新生血管,经抗排斥反应治疗后痊愈,无一例肿瘤复发;3例(3眼)圆锥角膜患者矫正视力0.3～0.5,未出现排斥反应,无复发.结论 板层角膜移植术是治疗多种角膜病变的有效术式.     

117例穿透性角膜移植患者的病因分析

目的总结2002年12月～2004年4月在我院接受穿透性角膜移植手术患者的流行病学资料,并将其与国外类似报道比较.方法对相应的临床资料做回顾性分析.结果在上述时间内共进行117例穿透性角膜移植.其中男性82例,女性35例.平均年龄45.5±18.7岁(8～75岁).角膜移植的病因按病例数由多至少依次为角膜炎后角膜白斑,计38例(33.48％),其中,尤以病毒性角膜炎为主.外伤后角膜疤痕及大泡性角膜病变占第二位,各17例(14.53％),随后为移植片排斥、真菌性角膜溃疡、圆锥角膜、角膜营养不良、以及原因不明的角膜白斑.圆锥角膜组的平均年龄为21.83±8.3岁(15～33岁),较平均年龄小(P＜0.01).而大泡性角膜病变组的平均年龄为60±16.65岁(25～84岁),较平均年龄大(P＜0.01).结论与发达国家不同,角膜炎后角膜白斑,外伤后角膜疤痕,大泡性角膜病变依次是角膜移植最常见的原因.     

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。     

深板层角膜移植术的临床应用及疗效

目的临床总结应用深板层角膜移植术治疗圆锥角膜,深及角膜后板层的角膜斑翳,角膜溃疡,边缘性角膜变性以及格子样角膜营养不良的治疗效果,探讨深板层角膜移植术的临床应用适应症。方法总结2001年1月至2005年5月深圳市眼科医院住院行深板层角膜移植的患者共14例(18只眼),其中圆锥角膜2例,(病毒性)角膜斑翳2例,(细菌性)角膜斑翳2例,真菌性角膜溃疡2例,细菌性角膜溃疡3例,边缘性角膜变性3例(5只眼),格子样角膜营养不良2例(4只眼)。记录术后半年复诊视力及角膜曲率,并统计角膜移植并发症的发生。综合评估该手术的临床适应症。结果有2例发生排斥反应,其中1例为病毒性角膜斑翳,1例为真菌性角膜溃疡。有3例原发病复发,2例真菌性角膜溃疡,1例病毒性角膜溃疡。术后视力半年时查0.5以上的有13例,0.1以上的有2例,0.1以下的有3例。结论深板层角膜移植对治疗未及角膜后弹力层的病变有效,但在治疗感染性角膜溃疡及病毒性角膜斑翳的治疗效果差,易发生原发病的复发及角膜移植排斥反应。     

再次穿透性角膜移植术的病因分析

目的 分析再次穿透性角膜移植术的病因.方法 对再次穿透性角膜移植术的94例(95眼)患者的原发疾病和再次手术的直接原因进行回顾性研究.结果 本组病例中,男性69例(70眼),女性25例(25眼),年龄2～80岁,平均(43±2)岁.所有病例的原发病因依次为:感染性角膜炎36例(36眼,37.9%),角膜白斑23例(23眼,24.2%),大泡性角膜病变12例(12眼,12.6%),角膜烧伤10例(11眼,11.6%),角膜营养不良或变性5例(5眼,5.3%),圆锥角膜1例(1眼,1.1%),其他7例(7眼,7.4%).再次角膜移植术的直接原因依次为:移植物排斥81例(83眼,87.4%),慢性角膜内皮失代偿6例(6眼,6.3%),原发性角膜内皮衰竭3例(3眼,3.2%),原发病复发3例(3眼,3.2%).结论 再次角膜移植术的直接原因以移植物排斥为主,原发病因以感染性角膜炎为主.     

甘油冷冻保存角膜深板层移植治疗真菌性角膜溃疡的临床研究

目的探讨甘油冷冻保存的供体角膜行深板层角膜移植术治疗浅、中层真菌性角膜溃疡的手术适应证及临床效果。方法57例（57眼）经综合抗真菌措施治疗无效的浅、中层真菌性角膜溃疡施行深板层角膜移植术,随访8～24月,观察术后复发率、视力恢复、植片透明及并发症发生情况。结果57例中,52例治愈,成功率91.23%;5例复发,复发率8.77%。矫正视力0.1～0.2者20眼,0.3～0.5者24眼,〉0.5者13眼。17例出现新生血管;13例发生排斥反应,均得到有效控制。植片全部透明。结论使用甘油冷冻保存的角膜供体行深板层角膜移植术既能及时去除病变组织,达到治疗目的,又有一定的增视效果,对药物治疗无效的浅、中层真菌性角膜溃疡是有效的手术方式。     

角膜移植手术概况

角膜移植是利用异体的正常角膜组织取代混浊病变的角膜组织,使患眼复明或控制角膜病变的治疗手段.传统角膜移植分为穿透性角膜移植和板层角膜移植术,随着人们对角膜病认识程度的加深以及新技术新器材的使用,带角膜缘的板层移植联合中央部分穿透性角膜移植术、深板层角膜移植、深板层角膜内皮移植术、角膜缘移植等多种新的手术方式较之传统术式具有更好的光学效果,并大大减少了术后排斥反应、散光等并发症.此外准分子激光和飞秒激光的应用也使角膜移植术的手术效果更趋完美.同时,人工角膜移植手术为不适合传统穿透性角膜移植手术的患者提供一种新的选择.本文对准分子激光和飞秒激光应用于穿透性角膜移植、各种类型板层角膜移植以及人工角膜移植手术进行简要概述,并展望角膜移植手术的发展趋势.     

121例儿童角膜移植手术的临床分析

目的探讨上海市儿童角膜移植患者的疾病分类、年龄及性别分布等临床特点。方法通过多中心合作的方式,回顾性分析上海市4所医院于2003年1月至2006年1月期间121例（122只眼）连续住院进行角膜移植手术患儿的临床资料。患儿年龄均在17岁以下。应用SPSS13．0统计软件分析患者的原发病、年龄及性别等数据。结果121例（122只眼）息儿中,外伤性角膜瘢痕27例（22．3％）,角膜炎后角膜白斑24例（19．8％）,先天性角膜混浊14例（11．6％）,圆锥角膜13例（10．7％）,角膜溃疡11例（9．1％）,移植物排斥6例（5．0％）,带状角膜变性6例（5．0％）,化学伤6例（5．0％）,热灼伤5例（4．1％）,皮样瘤5例（4．1％）及先天性遗传性角膜内皮营养不良4例（3．3％）。患儿中,男性77例,女性44例,男女性比例为1．75：1．00。患儿年龄四分位数范围为8～14岁,中位数为11岁。角膜移植患儿手术以穿透性角膜移植术为主,为95例（78．5％）;行板层角膜移植术患者为19例（15．7％）;穿透性角膜移植术联合其他手术为7例（5．8％）。结论外伤性角膜瘢痕和角膜炎后角膜白斑是儿童角膜移植手术的主要原因。角膜移植患儿以学龄期儿童为主,且男性比例较高。     

2000至2009年角膜移植手术适应证变化趋势的研究

目的 探讨2000至2009年山东省眼科研究所青岛眼科医院开展角膜移植手术的手术适应证,并比较前5年与后5年手术适应证的变化.方法 对2000年1月至2009年12月山东省眼科研究所青岛眼科医院行角膜移植手术病例的资料进行回顾性调查.2000至2009年角膜移植术3649例(3741只眼)资料完整,其中男性2518例(2582只眼),女性1131例(1159只眼);穿透性角膜移植术(PKP)2594例(2667只眼),板层角膜移植术(LKP)1055例(1074只眼).分析2000至2004、2005至2009年2个时间段角膜移植手术的适应证及其变化.结果 前5年PKP适应证依次为化脓性角膜炎(440例,442只眼)、圆锥角膜(241例,274只眼)、病毒性角膜炎(229例,229只眼),LKP适应证依次为化脓性角膜炎(221例,221只眼)、角膜烧伤(包括角膜化学伤和热烫伤;106例,106只眼)、其他原因(包括泡性角膜炎、角膜基质炎等;79例,79只眼),PKP(1352只眼)与LKP(548只眼)之比为2.5∶1.0.后5年PKP适应证依次为化脓性角膜炎(330例,330只眼)、病毒性角膜炎(124例,124只眼)、圆锥角膜(99例,105只眼),LKP适应证依次为化脓性角膜炎(230例,236只眼)、圆锥角膜(97例,101只眼)、角膜营养不良和角膜变性(42例,49只眼),PKP(876只眼)与LKP(508只眼)之比为1.7∶1.0.结论 化脓性角膜炎是角膜移植手术的主要适应证,LKP术式的选择明显增加,已成为化脓性角膜炎、圆锥角膜的首选手术方式.

Abstract：

Objective To analyzed retrospectively the indications of corneal transplantations,including penetrating keratoplasty(PKP) , lamellar keratoplasty (LKP) and corneal transplantation combined with anterior and posterior segment surgery in Qingdao Eye Hospital, Shandong Eye Institute. And compare the changes of the indications between the first five years and the last five years. Methods The patients who received PKP, LKP and corneal transplantation combined with anterior and posterior segment surgeries in Qingdao Eye Hospital, Shandong Eye Institute between January 2000 and December 2009 were reviewed retrospectively. From 2000 to 2009, 3649 cases(3741 eyes)of corneal transplantations have complete data,including male 2518 cases(2582 eyes) ,female 1131 cases (1159 eyes) ;PKP 2594 cases (2667 eyes) ,LKP 1055 cases (1074 eyes). Compare and analysis the indications and its changes between 2000 -2004and 2005 - 2009 two periods . Results During the first period, the leading indications for PKP, in order of decreasing frequency, were purulent keratitis (440 cases, 442 eyes) , keratoconus (241 cases, 274 eyes) ,herpes simplex keratitis ( HSK) (229 cases, 229 eyes) , the leading indications for LKP were purulent keratitis (221 cases, 221 eyes), corneal burn (including thermal and chemical burn) (106 cases, 106eyes) , others (mainly refers to the phlyctenular keratitis, interstitial keratitis, et al) (79 cases, 79 eyes) ,the ratio of PKP and LKP is 2. 5 to 1. 0. During the second period the leading indications for PKP, in order of decreasing frequency, were purulent keratitis (330 cases, 330 eyes), HSK (124 cases, 124 eyes),keratoconus (99 cases, 105 eyes), the leading indications for LKP were purulent keratitis (230 cases,236 eyes) , keratoconus(97 cases, 101 eyes) , corneal dystrophy and degeneration (42 cases, 49 eyes) ,the ratio of PKP and LKP is 1.7 to 1. 0. Conclusions Purulent keratitis is the main indication of corneal transplantion, the choice of LKP significantly increase. LKP has become the first surgical choice of purulent keratitis and keratoconus.     

Indications of penetrating keratoplasty in northern India

PURPOSE: To identify the indications for penetrating keratoplasty in northern India. METHODS: All the eye bank records of penetrating keratoplasties performed during the period from June 1997 to November 2003 at Rajendra Prasad Center for Ophthalmic Sciences were reviewed. RESULTS: During this period, 2022 penetrating keratoplasties were performed. The leading indications for penetrating keratoplasty were corneal scarring (38.03%) followed by acute infectious keratitis (28.38%), regrafting (11.5%), aphakic bullous keratopathy (7.27%), pseudophakic bullous keratopathy (6.18%), and corneal dystrophy (3.85%). Healed infectious keratitis (19.83%) was the most common subcategory among the eyes with corneal scarring followed by traumatic corneal scars (16.71%). Healed (19.83%) and active keratitis (28.38%) together accounted for the majority of keratoplasties (48.21%). In cataract-related corneal edema (13.45%), aphakic bullous keratopathy (7.27%) was almost as frequent as compared with pseudophakic bullous keratopathy (6.18%). CONCLUSIONS: Corneal infections either active or healed are the most common indication for keratoplasty in northern India.     

Big-bubble deep anterior lamellar keratoplasty for post-keratitis and post-traumatic corneal stromal scars

Background: Evaluation of outcomes of big‐bubble deep anterior lamellar keratoplasty in cases with post‐keratitis and post‐traumatic corneal scars. Design: Interventional case series. Participants: Patients with corneal stromal scarring secondary to healed infectious keratitis or trauma were recruited from the Corneal Clinic of the M. M. Joshi Eye Institute, Karnataka, India between August 2007 and December 2009. Methods: All patients underwent big‐bubble deep anterior lamellar keratoplasty surgery. Main Outcome Measures: Best‐corrected visual acuity, as well as intra‐ and postoperative complications. Results: Big‐bubble deep anterior lamellar keratoplasty was performed in 36 patients (25 males, 11 females) with post‐infectious keratitis (n = 22) and post‐traumatic (n = 14) corneal stromal scars sparing the Descemet's membrane and endothelium. Mean age was 39.7 ± 11.3 years (range: 22–58 years). Although a big bubble was achieved in all eyes (100%), intraoperative perforation of the Descemet's membrane occurred in six eyes (16%) during stromal dissection. Two cases required conversion to penetrating keratoplasty. A double anterior chamber occurred in the immediate postoperative period in three cases (8.3%). Raised intraocular pressure was seen in one eye. Mean preoperative best‐corrected visual acuity (0.03 ± 0.04) improved significantly at the end of 6 months follow‐up postoperatively (0.43 ± 0.20; P < 0.01, Wilcoxon signed‐ranks test). Corneal stromal graft rejection was noted in two cases (5.5%) during the first 3 months after surgery. Graft failure occurred in two cases (5.5%). Conclusions: Deep anterior lamellar keratoplasty using the big‐bubble technique is a viable option in cases with post‐infectious keratitis and post‐traumatic corneal stromal scarring with normal Descemet's membrane and endothelium.     

Trends in the indications for penetrating keratoplasty in Shandong,2005-2010

AIM:To identify the current indications and the trend shifts for penetrating keratoplasty(PKP) in Shandong.METHODS:The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1,2005 to May 31,2010 were analysed retrospectively.RESULTS:A total of 875 patients(875 eyes) received PKP in this 5-year period,accounting for 61.6% of all corneal transplantation surgeries.The leading indications for PKP were infectious keratitis(37.1%),HSK(19.1%),keratoconus(11.2%),bullous keratopathy(8.5%),regrafting(6.7%) and corneal scarring(4.8%).The percentage of PKP for keratoconus declined year by year,whereas the percentage of bullous keratopathy had a mild annual increase.Fungal infections accounted for 65.2% of the infectious keratitis cases,remaining the leading cause of corneal infection.In addition,54.1% of bullous keratopathy cases were associated with cataract surgery.The leading initial diagnoses associated with regrafting were infectious keratitis(38.9%),HSK(18.6%) and corneal burn(16.9%).The major causes of regrafting included graft endothelial dysfunction(39.0%),graft ulcer(28.8%) and primary disease recurrence(15.3%).CONCLUSION:Infectious keratitis remained the leading indication for PKP in Shandong,and fungal infections were still the major cause of corneal infections.There was an increasing trend in the percentage of PKP cases indicated for bullous keratopathy but a decline in the same for keratoconus.Even with a decline in the overall proportion among all corneal transplantation surgeries,PKP is still the major corneal transplant choice in Shandong.     

Indications for penetrating keratoplasty: 1980-1988

A retrospective analysis was undertaken of the clinical diagnoses of 1594 eyes that underwent penetrating keratoplasty performed in a private-referral corneal practice over a 9-year period, 1980-1988. The seven most common indications for surgery were keratoconus (24.0%), pseudophakic or aphakic bullous keratopathy (21.2%), corneal scarring (13.9%), Fuchs' endothelial dystrophy (12.5%), regraft (8.1%), and herpetic keratitis (5.3%). Keratoconus was the leading indication from 1980 to 1985. From 1985 to 1988, pseudophakic bullous keratopathy became the leading indication and correlates well with known complications associated with closed-loop anterior chamber lenses, which were widely used during the early 1980s. Less frequent indications for penetrating keratoplasty included the following: infectious (nonviral) keratitis (3.5%); acute or chronic ulcerative keratitis (2.7%); interstitial keratitis (1.8%); mechanical trauma (1.5%); other (non-Fuchs') corneal dystrophies (1.4%); congenital opacities (0.8%); and chemical burns (0.5%).     

Trends in the indications for penetrating keratoplasty in Shandong, 2005-2010

AIM: To identify the current indications and the trend shifts for penetrating keratoplasty (PKP) in Shandong. METHODS: The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1, 2005 to May 31, 2010 were analysed retrospectively. RESULTS: A total of 875 patients (875 eyes) received PKP in this 5-year period, accounting for 61.6% of all corneal transplantation surgeries. The leading indications for PKP were infectious keratitis (37.1%), HSK (19.1%), keratoconus (11.2%), bullous keratopathy (8.5%), regrafting (6.7%) and corneal scarring (4.8%). The percentage of PKP for keratoconus declined year by year, whereas the percentage of bullous keratopathy had a mild annual increase. Fungal infections accounted for 65.2% of the infectious keratitis cases, remaining the leading cause of corneal infection. In addition, 54.1% of bullous keratopathy cases were associated with cataract surgery. The leading initial diagnoses associated with regrafting were infectious keratitis (38.9%), HSK (18.6%) and corneal burn (16.9%). The major causes of regrafting included graft endothelial dysfunction (39.0%), graft ulcer (28.8%) and primary disease recurrence (15.3%). CONCLUSION: Infectious keratitis remained the leading indication for PKP in Shandong, and fungal infections were still the major cause of corneal infections. There was an increasing trend in the percentage of PKP cases indicated for bullous keratopathy but a decline in the same for keratoconus. Even with a decline in the overall proportion among all corneal transplantation surgeries, PKP is still the major corneal transplant choice in Shandong.     

Indications for penetrating keratoplasty in north China

PURPOSE: To analyze leading indications for penetrating keratoplasty (PKP) in north China and changing trends in them. METHODS: We retrospectively reviewed the records of patients who underwent PKP at Shandong Eye Institute from January 1997 to December 2002. Infectious keratitis (fungal, bacterial, and acanthamoeba), herpes simplex keratitis (HSK), corneal scarring, keratoconus, bullous keratopathy, regrafting, corneal dystrophy and degeneration, and others were included in the indications for PKP. Initial diagnoses and causes of regrafting were recorded, as well as the related intraocular surgeries for bullous keratopathy. RESULTS: A total of 1702 patients (1702 eyes) were included in this study. The leading indications for PKP were infectious keratitis (31%), followed by HSK (18%), corneal scarring (16%), keratoconus (13%), bullous keratopathy (7%), regrafting (5%), and corneal dystrophy and degeneration (4%). Percentage of PKP for keratoconus and bullous keratopathy increased significantly during the 6 years, contrary to HSK and corneal scarring. Fungal infections accounted for 66% of infectious keratitis. Of 118 bullous keratopathy cases, 90 (76%) were associated with cataract surgery. The leading initial diagnoses of regrafting were corneal burns (25%), HSK (23%), and infectious keratitis (14%); the major causes included immune rejection (61%), graft infection (14%), and recurrence of HSK (10%). CONCLUSIONS: Infectious keratitis remains the most common indication for PKP in north China. Moreover, there is an increasing trend in the percentage of PKP for keratoconus and bullous keratopathy.     

Retrospective analysis of deep lamellar keratoplasties

BACKGROUND: Purpose of this retrospective study was to analyse the outcome of deep lamellar keratoplasty. PATIENTS AND METHODS: The records of 9 patients with deep lamellar keratoplasty were reviewed. Age, sex, systemic diseases, indication for surgery, pre- and postoperative visual acuity and findings, visual acuity and findings at last follow-up and complications were noted. RESULTS: Nine eyes of 9 patients have been operated with the "big bubble" technique described by Anwar. Indications for operation were keratoconus (4), keratoglobus (1), central corneal scar after keratitis (3) and after alkali burn (1). In 3 cases the intraoperative technique had to be changed to penetrating keratoplasty. The preoperative visual acuity was 0.2 to 0.3. All 9 patients showed a postoperative improvement of visual acuity: best corrected from 0.3 to 0.8. In one eye particles in the interface were found. At last follow-up all grafts were clear. There were no postoperative complications. CONCLUSIONS: The results demonstrate that deep lamellar keratoplasty is a technically difficult procedure, in 3 out of 9 patients the operation method failed. The postoperative course after deep lamellar keratoplasty did not show any severe complications. The patients who had to be changed to penetrating keratoplasty were not disadvantaged in respect of the final result (visual acuity and findings). The postoperative visual acuities after deep lamellar keratoplasty and after penetrating keratoplasty were comparable. Despite the small number of patients and the relatively short observation period, we noticed that after deep lamellar keratoplasty the sutures could tendentially be removed earlier and thus the duration of topic steroids therapy was shorter compared to penetrating keratoplasty.     

Indications for penetrating keratoplasty and anterior lamellar keratoplasty during 2010-2017

AIM: To review the indications of penetrating keratoplasty (PK) and anterior lamellar keratoplasty (ALK) at Qingdao Eye Hospital, Shandong Eye Institute, Qingdao, China, from 2010 to 2017. METHODS: The data of all patients undergoing PK or ALK from January 2010 to December 2017 was retrospectively reviewed, with the indications during 2010-2013 and 2014-2017 compared. RESULTS: A total of 1869 eyes were included, among which 1405 eyes (75.2%) had PK and 464 eyes (24.8%) had ALK. The leading indications were suppurative keratitis (36.8%), keratoconus (15.5%), herpes keratitis (13.1%), and regraft (10.5%). In eyes undergoing PK, the top four indications were suppurative keratitis (38.7%), herpes keratitis (15.3%), keratoconus (12.6%), and regraft (12.5%) during 2014-2017, with the proportion of suppurative keratitis and herpes keratitis decreased while regraft and keratoconus increased compared with 2010-2013. In eyes with ALK, suppurative keratitis (30.8%), keratoconus (24.1%), corneal dystrophies and degenerations (10.6%), and corneal dermoid tumor (9.7%) were the top four indications, and there was no significant difference for the proportion of each indication between 2010-2013 and 2014-2017. CONCLUSION: Suppurative keratitis is the most common indication for PK and ALK at Qingdao Eye Hospital during 2010-2017, followed by keratoconus, herpes keratitis, and regraft. In eyes treated with PK, the proportion of suppurative keratitis and herpes keratitis decrease while regraft and keratoconus increase during 2014-2017 compared with 2010-2013.