穿透性角膜移植治疗真菌性角膜溃疡穿孔的疗效评价

目的:评价穿透性角膜移植术（PKP）治疗真菌性角膜渍疡穿孔的疗效。方法:采用新鲜供体角膜19只、甘油冷冻保存的供体角膜2只,对本院收治的21例真菌性角膜溃疡穿孔患者行PKP治疗,随访6～33月,平均13.93月。结果:术后植片透明13眼,植片透明率为61.90％。除一眼眼球萎缩外,其余患者均保存了眼球。术后:真菌复发4眼（19.05％）;免疫排斥反应8眼（38.10％）;并发性白内障5眼（23.81％）;继发性青光眼2眼（9.52％）;虹膜后粘伴瞳孔改变6眼（28.56％）;植片无菌性溃疡1眼（4.76％）。结论:真菌性角膜溃疡穿孔的病例,通过合理用药和及时手术,完全可以获得较好疗效,但是术后并发症较多应该加强随访。     

角膜冷溃疡手术治疗的临床疗效观察

目的 观察不同手术方法 治疗角膜冷溃疡的临床疗效.方法 回顾性分析2006年6月至2008年6月确诊为"角膜冷溃疡"的患者8例8只眼,其中4例选择结膜瓣遮盖术,4例行部分板层角膜移植术( lamellar keratoplasty,LKP),其中1例因植床穿孔改行穿透性角膜移植术( penetrating keratoplasty,PKP).术后随访4～10个月,平均6个月,观察视力、溃疡愈合及复发情况、角膜植片和植床透明度.结果行结膜瓣遮盖术者溃疡均治愈;行部分LKP术者植片透明,植床仅残留薄层瘢痕,行PKP术者植片透明,两者视力均有所提高.所有病例溃疡未见复发.结论 对于角膜冷溃疡,可根据不同病例的特点采取个体化的手术方式治疗,能获得比较满意的临床疗效.     

大植片深板层角膜移植治疗角膜深大溃疡

目的 评价大植片深板层角膜移植治疗角膜深大溃疡的效果。方法 行大植片深板层角膜移植术41例41眼。其中各类溃疡34例，严重碱烧伤6例，铁水烧伤1例。溃疡最大直径≥8mm，病灶中心深度均超过角膜基质层2／3厚度，其中2例有微穿孔。术前视力均低于0．05。术后随访6—12月。结果 术后1周37例植片透明，4例浑浊，上皮均修复。术后2周31例植片透明，7例浑浊，3例融解穿孔摘除眼球，出现排斥线9例。术后3月27例植片基本透明，11例浑浊；排斥反应4例；视力≥0．05 21例，视力手动—0．3。术后6月失访5例；23例透明，12例浑浊；真菌复发2例；视力≥0．05 19例。术后12月失访11例；16例透明，9例浑浊；排斥反应1例；视力≥0．05 17例。结论 大植片深板层角膜移植治疗角膜深大溃疡具有较好疗效。     

继发性角膜溃疡的临床治疗

目的:探讨继发性角膜溃疡的临床治疗方案。方法:回顾性分析我院2006-12/2008-12临床诊断为"继发性角膜溃疡"的患者8例8眼,其中4例选择结膜瓣遮盖术,3例行部分板层角膜移植术(lamellar keratoplasty,LKP),1例因角膜穿孔行穿透性角膜移植术(penetratingkeratoplasty,PKP)。术后随访4~10(平均6)mo,观察视力、溃疡愈合及复发情况、角膜植片和植床情况。结果:行结膜瓣遮盖术者溃疡均治愈;行部分LKP术者植片透明,植床残留薄层瘢痕,行PKP术者植片透明,两者视力均有所提高。所有病例溃疡未见复发。结论:对于继发性角膜溃疡,应该根据不同病例的特点采取个体化的手术方式治疗,从而获得比较满意的临床疗效。     

角膜缘上皮移植术治疗化学伤角膜白斑

目的介绍角膜缘上皮移植术治疗化学伤角膜白斑的技术并评价其疗效。方法手术切除角膜白斑和纤维血管化组织，用异体带角膜缘上皮的板层角膜移植给患者，对20例（28眼）化学伤角膜白斑进行治疗和观察．随访3个月至2年。结果10例（12眼）术后植片透明，视力0．1～0．3，另10例（16眼）植片大多数透明或半透明，视力有不同程度提高。结论角膜缘上皮移植术是治疗化学伤角膜白斑的有效方法。     

角膜小穿孔的手术治疗临床效果观察

目的观察总结角膜小穿孔的手术治疗效果。方法对12例13眼角膜小穿孔分别行穿透性角膜移植术、异体角膜修补术和羊膜移植术治疗。结果随访2~23月,术后末次随访矫正视力<0.1者2眼、0.1~0.4者5眼、≥0.5者6眼;12眼术后视力较术前提高,1眼下降。4眼发生暂时性高眼压。8眼行异体角膜修补术者,植片均浑浊;3眼行穿透性角膜移植术者,角膜植片保持透明;2眼行羊膜移植术者,角膜穿孔愈合,术区局部浑浊。结论累及瞳孔区的角膜小穿孔适合穿透性角膜移植术以获得较好视力;≤3 mm偏中心角膜小穿孔适合采用异体角膜修补和羊膜移植术。     

角膜内皮移植治疗穿透性角膜移植术后植片失代偿的长期疗效观察

目的 观察角膜内皮移植手术（EK）治疗穿透性角膜移植术（PKP）后植片失代偿的长期临床效果。设计 回顾性病例系列。 研究对象 选取2008至2010年爱尔眼科医院收治的接受PKP术后植片内皮失代偿的患者6例（6眼）。 方法 对上述患者实施EK手术,对患者的临床资料进行回顾性分析。记录并分析患者术后视力、眼压、内皮细胞密度、排斥反应及并发症等。平均随访时间为（36.17±10.11）个月。主要指标  视力、眼压、内皮细胞密度、排斥反应及并发症。结果 术后所有患者植片均恢复透明,视力较前有不同程度提高,症状缓解。末次随访时,1例患者角膜失代偿,其余5例内皮细胞密度从986~1914个/mm2。随访期内,1例术后1天发生植片半脱位,经再次前房注气后贴附良好;1例术后5个月发生免疫排斥反应,经药物治疗植片保持透明;另1例患者未规律随诊,内皮移植术后26个月时发生排斥反应,导致失代偿。结论 对于反复发生免疫排斥反应导致植片混浊的高危患者,角膜内皮移植手术是可供选择的治疗方法。     

穿透性角膜移植术治疗真菌性角膜溃疡手术适应证选择

目的探讨穿透性角膜移植术（PKP）治疗真菌性角膜溃疡的手术适应证选择的安全性和可行性。方法2000年1月至2005年12月在我院因真菌性角膜溃疡行PKP并具有完整病例资料的147例（147只眼）患者进行长期随访，并为3种手术适应证的选择提供客观的依据。结果随访10—70个月，平均为（25．4±13．9）个月。眼球保存率87．8％（129／147），真菌复发率为6．1％（9／147）。73．6％（95／129）患者角膜植片透明，最佳矫正视力44只眼介于0．1—0．3，51只眼介于0．4—0．8，较术前明显提高。结论药物治疗无效且感染已累及角膜全层、角膜穿孔的真菌性角膜溃疡行板层角膜移植（LKP）术后复发均是PKP治疗真菌性角膜溃疡的适应证选择范围。病理组织学可以为PKP手术适应证选择的可行性提供可靠的理论依据；而术后疗效的长期随访则进一步证实了其安全性。     

增视性角膜移植术后角膜植片透明率及影响因素

目的：探讨增视性角膜移植术后角膜植片的透明率及其影响因素。 方法：回顾性病例研究。选择2004-01/2005-12于青岛眼科医院行增视性穿透性角膜移植术（optical penetrating keratoplasty,PKP）的患者97例105眼,包括圆锥角膜,角膜基质营养不良,外伤、感染等因素导致的角膜白斑,单纯疱疹病毒性角膜炎稳定期,角膜内皮细胞功能失代偿等。统计分析术前视力及术后最佳矫正视力、角膜植片透明情况、内皮细胞计数、是否排斥、植片混浊原因,采用R×C表及四格表的χ2检验。 结果：增视性PKP术后角膜植片透明率：术后1a 89.8%,术后2a 83.7%,术后3a 78.3%,术后4a 67.1%,术后5a 63.6%。术后5a时圆锥角膜角膜植片透明率最高,达94.1%,角膜内皮功能失代偿最低,为14.3%。术后最佳矫正视力0.05~1.0,0.8以上者圆锥角膜所占比例最多,达72.5%,角膜内皮功能失代偿最少,占6.3%。导致角膜植片混浊的主要原因为角膜植片免疫排斥及角膜植片内皮细胞功能失代偿。 结论：增视性PKP术后角膜植片透明率逐年稳定下降,相邻两年之间无显著性差异;原发病不同,角膜植片透明率有差异,圆锥角膜手术效果最佳;角膜植片混浊的主要原因为免疫排斥及角膜植片内皮功能失代偿。     

236例儿童穿透性角膜移植术的临床分析

目的探讨儿童穿透性角膜移植术（PKP）的病因、预后及影响预后的因素。方法选择1994年6月至2004年6月期间于山东省眼科研究所青岛眼科医院就诊的236例（257只眼）年龄小于14岁（3个月至14岁）、因各种原因角膜异常行PKP或PKP联合其他手术的患儿,共行266次PKP,随访时间6个月至9年5个月,平均为（21±13）个月。回顾性分析儿童PKP的病因特点、术后随访观察结果及影响儿童PKP预后的因素。结果儿童PKP的手术病因依次为先天性、发育性及与遗传有关的角膜疾病（99只眼,38．5％）、与角膜外伤有关的角膜疾病（82只眼,31．9％）、与角膜炎性反应有关的角膜疾病（76只眼,29．6％）。至最后一次随访,146只眼最佳矫正视力〉0．05,脱盲率为56．8％,其中与角膜炎性反应有关的角膜疾病占37．7％（55／146）,9～14岁患儿占55．5％（81／146）。角膜植片总透明率为71．4％（190／266）,单纯PKP角膜植片透明率为71．5％（138／193）,行PKP联合其他手术的角膜植片透明率为71．2％（52／73）,两者比较差异无统计学意义（x^2=0．002,P=0．965）;双眼手术的角膜植片透明率为50％（24／48）,单眼手术的角膜透明率76．1％（166／218）,两者之间比较差异有统计学意义（x^2=13．178,P=0．000）。有9例（12只眼）患儿接受21次重复PKP,角膜植片透明率为38．1％（8／21）,与一次PKP术后角膜植片透明率（74．3％,182／245）间比较差异有统计学意义（x^2=12．413,P=0．000）。结论先天性、发育性及与遗传有关的角膜疾病是儿童行PKP的主要病因;手术预后受手术病因、发病年龄、是否联合玻璃体手术及是否双眼手术等多种因素的影响。（中华眼科杂志,2007,43：1005-1009）     

Topical anesthesia for penetrating keratoplasty

PURPOSE: To evaluate the use of topical anesthesia for penetrating keratoplasty (PKP) in situations where retrobulbar, peri/parabulbar, or general anesthesia are inadvisable or not readily available. METHODS: This was a retrospective analysis of a consecutive case series consisting of 8 eyes in 8 patients who had PKP with topical anesthesia between September 1995 and December 1997 in cases where retrobulbar, peri/parabulbar, or general anesthesia either could not be performed or presented too great a risk to the patient. Some cases were supplemented with small limbal injections, mild intravenous sedation (fentanyl), and/or intraocular anesthesia. In one case, intraocular 1% lidocaine was placed directly into the vitreous cavity to allow an open-sky vitrectomy. RESULTS: In all cases, PKP was completed without complications. All patients tolerated the procedure well and reported only mild discomfort. However, in 2 cases, an ACIOL was left in place because lens manipulation caused pain in the ciliary body and iris root areas. CONCLUSIONS: PKP can be performed successfully with topical anesthesia in cooperative patients who have perforated corneal ulcers, significant anticoagulation, or severe medical conditions, which make alternative forms of anesthesia more risky.     

不同种族角膜植片对穿透性角膜移植术效果的影响

目的 通过观察不同种族间穿透性角膜移植手术的效果,总结不同种族之间穿透性角膜移植的可行性。设计 回顾性病例系列。研究对象 北京同仁眼科中心2002年10月至2003年3月因角膜白斑、角膜内皮失代偿、角膜移植术后植片失败等接受穿透性角膜移植术患者10例（10眼）。方法 采用国际组织库提供的中期保存角膜植片进行穿透性角膜移植术,其中高加索人种角膜8片,西班牙人种1片,非洲人种1片。术前收集患者资料,术后进行随访和临床观察,评价角膜植片的存活情况以及疗效。主要指标 视力,角膜植片透明度,角膜新生血管分级。结果 10例患者平均随访（12.6±3.86）个月,4例患者角膜植片基本保持透明,视力平均提高1~2行。6例（60%）患者出现植片混浊、植片水肿、新生血管长入等排斥反应,视力不提高。结论 本文小样本观察显示不同种族角膜供体可以用于穿透性角膜移植治疗。（眼科, 2013, 22:98-100）     

穿透性角膜移植术治疗真菌性角膜溃疡穿孔

目的 探讨穿透性角膜移植术治疗真菌性角膜溃疡穿孔的临床疗效。方法 对1994年至2003年在青岛眼科医院行穿透性角膜移植术的40例（40只眼）真菌性角膜溃疡穿孔患者进行随访,随访时间为6～24个月,观察术后视力变化和真菌复发、植片排斥、继发性青光眼、并发性白内障等并发症的发生情况。结果 40例患者中,39例（97．5％）成功地保存了眼球,38例（95．0％）不同程度地提高了视力。穿透性角膜移植术后,4例（10．0％）患者真菌复发,其中3例用药物治愈,1例因合并真菌性眼内炎用药物不能控制而摘除眼球;15例（37．5％）患者植片发生排斥,其中12例经抗排斥治疗植片转为透明,3例因药物治疗无效而行二次穿透性角膜移植术;3例（7．5％）患者植片发生溃疡,其中2例治愈,1例因合并角膜内皮功能失代偿而行二次穿透性角膜移植术;5例（12．5％）患者继发青光眼,眼压均得到成功控制;5例（12．5％）患者发生并发性白内障,其中3例行白内障摘除术。其余患者术后随访期间眼部情况稳定,植片保持透明。最终随访时,36例（90．0％）患者角膜植片透明。结论 穿透性角膜移植术是治疗真菌性角膜溃疡穿孔的有效手术方式,是挽救眼球和视力的主要手段。     

Combined topical and intracameral anesthesia in penetrating keratoplasty

BACKGROUND: The standard of care for penetrating keratoplasty (PKP) is either retrobulbar or peribulbar anesthesia combined with seventh cranial nerve akinesia or general anesthesia. These methods are known to be associated with rare but potentially serious adverse ocular and systemic events. PURPOSE: To determine the safety and efficacy of combined topical and intracameral anesthesia in addition to intravenous sedation for repeat penetrating keratoplasty (PKP). SETTING: Tertiary-care university hospital. METHODS: In this prospective study, combined topical tetracaine 0.5% and 0.2 cc intracameral 1% lidocaine along with i.v. sedation with midazolam and fentanyl were used for patients undergoing repeat PKP in 15 eyes of 15 selected patients. The indication for surgery was failed corneal graft. Verbal pain scale (VPS, 0-3) was recorded preoperatively, intraoperatively at 3 time-points (after trephination, after placing 8 interrupted sutures, and after placing the running suture), and postoperatively (1 hour postoperatively, overnight pain, and 1 day postoperatively). Patient and surgeon satisfaction were assessed postoperatively using a scale (1-5). After surgery patients were asked for their preferences comparing the current use of topical anesthesia compared with retrobulbar anesthesia used for their initial PKP. RESULTS: The mean intraoperative VPS score was 0.51 +/- 0.32 (range 0-1.33), and the mean postoperative VPS score was 0.47 +/- 0.50 (range 0-1.67). There were no serious intraoperative or postoperative complications. All patients reported high mean satisfaction score of 4.67 +/- 0.49 (range 4-5). The mean satisfaction score reported by the surgeon was 4.47 +/- 0.63 (range 3-5). All patients but 1 (93.3%) preferred combined topical over retrobulbar anesthesia, which they had in their previous surgery. CONCLUSIONS: We found combined topical and intracameral anesthesia to be safe and effective in our selected group of patients undergoing repeat PKP, and it may provide a satisfactory alternative anesthetic modality for patients in whom general, retrobulbar, or peribulbar anesthesia may be contraindicated.     

Graft survival and glaucoma outcome after simultaneous penetrating keratoplasty and ahmed glaucoma valve implant

PURPOSE: To investigate the success of corneal graft and intraocular pressure (IOP) control after simultaneous penetrating keratoplasty (PKP) and Ahmed glaucoma valve implant in patients with coexisting corneal opacity and glaucoma. METHODS: A retrospective review was undertaken of adult patients at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, who underwent simultaneous PKP and Ahmed glaucoma valve implant between January 1994 and September 1999.RESULTS: Twenty-five eyes of 25 patients were included in the study. Cumulative probabilities of success by Kaplan-Meier analysis showed 92% and 50% graft success and 92% and 86% IOP control at 1 and 3 years, respectively. The main postoperative complication was graft failure in 10 of 25 cases, and the majority of those failures resulted from immunologic graft rejection and tube endothelial touch.CONCLUSION: Ahmed glaucoma valve implant is effective in controlling IOP in a majority of eyes during a 3-year time span. However, corneal graft success continues to pose challenges.     

表麻下小切口非超声乳化白内障手术并发症探讨

目的 观察表麻下小切口非超声乳化白内障手术术中、术后并发症，对其进行分析并提出处理意见。方法 102例(102只眼)白内障，术中表面麻醉后，采用圈垫式劈核技术，手法碎核，进行小切口非超声乳化白内障摘除并人工晶状体植人术。结果 术中：虹膜脱出12只眼，虹膜根部离断1只眼，晶状体后囊破裂7只眼。术后：角膜内皮条样浑浊30只眼，片状浑浊10只眼，前房纤维素样渗出10只眼，继发青光眼1只眼。结论 表麻下小切口非超声乳化白内障手术避免了球周、球后麻醉带来的一系列并发症。对晶状体核的处理较关键，亦是易产生并发症的步骤。     

Tectonic epikeratoplasty: a surgical procedure for corneal melting

BACKGROUND AND OBJECTIVE: Tectonic epikeratoplasty (TEK) is a method in which a corneal button, preserved in glycerin is used as a seal over corneal perforation. The graft is sutured to the recipient sclera, upon the sick melted cornea, with silk sutures, after 360 degree peritomy of the conjunctiva. The graft is left in place for a few weeks, and by that time the cornea is completely healed. We describe our experience in TEK as a method of treatment for selected cases of melted cornea or descemetocele. METHODS AND PATIENTS: We review 12 TEK operations done in our department over the period of 1992 to 1997, and describe the outcome in each case. RESULTS: The 12 TEK operations included 9 eyes of 9 patients. The patients, 7 males and 2 females, suffered from ocular surface disturbances including indifference to pain syndrome, Steven-Johnson syndrome, dry eye, relapsing herpetic keratitis, post-traumatic corneal thinning, and local anesthetic abuse. Six of the 9 eyes had leaking perforated corneal ulcer, and the remaining 3 had an imminent perforation caused by descemetocele or melting. All the grafts but one fell off the eyes between 10 and 21 days following surgery. In most of the cases the leakage ceased, and a scar sealing the perforation site was observed. One eye had gone through this procedure 3 times, and another eye had gone through it twice. In only 3 cases did the procedure fail to eliminate leakage, and another TEK or urgent penetrating keratoplasty (PKP) was done. CONCLUSIONS: TEK is an available method for saving the integrity of the globe when PKP is not possible. Although it increases corneal vascularity, PKP can be done later under optimal conditions.     

Validation of tissue quality parameters for donor corneas,designated for emergency cases: corneal graft survival

Purpose: To validate tissue quality parameters for donor corneas designated for emergency grafting for corneal graft survival. Methods: In a longitudinal cohort follow‐up study, 131 emergency penetrating grafts were studied. Grafts were performed with a pool of organ‐cultured donor corneas designated for emergency grafting and prepared for immediate use with all safety tests performed. Assignation criteria were: corneas with a small superficial stromal opacity but meeting all selection criteria for PKP tissue and corneas without stromal opacity, but an endothelial cell density from 1800 to 2300 cells/mm² or mild polymegathism or pleomorphism. Cox multivariate regression analysis, Kaplan–Meier survival and log rank test were applied. Results: Of the 131 keratoplasties, 115 could be followed. One eye was lost during surgery because of an expulsive bleeding. In 15 cases, a conjunctival transplantation finished off the penetrating graft. Corneal graft survival was not significantly related to the presence of PKP quality of the donor endothelium, neither with a cloudy graft nor with endothelial decompensation as the cause of failure. Main risk factors for a failed graft were vascularization of the host cornea (p = 0.0001), the presence of a systemic auto immune disease in the recipient (p = 0.003) and the disease leading to the (imminent) perforation and emergency graft (p = 0.021). Conclusion: A selected pool of donor corneas designated for emergency grafting that does not interfere with the scheduled procedures allows more efficient and safe use of donor tissue in case of a(n) (imminent) perforation. Corneal graft survival rates justify the criteria for selection.