重度角膜烧伤后患者行穿透性角膜移植联合异体角膜缘移植术的疗效分析

目的　探讨穿透性角膜移植(PK)联合环状同种异体角膜缘移植(KLAT)治疗重度角膜烧伤(稳定期)后角膜白斑伴角膜缘干细胞功能失代偿的临床疗效。方法　1999年1月至2001年12月山东省眼科研究所、青岛眼科医院诊治的稳定期重度角膜烧伤患者34例(35只眼),平均病程2 8年。角膜新生血管化象限均大于3 /4,角膜中央全层混浊区直径大于6mm,术前视力在光感/1m~数指/30cm之间。A组18例(19只眼)接受PK联合KLAT术;B组16例(16只眼)接受眼前节重建(带角膜缘的全角膜移植)术。术后全身联合局部应用免疫抑制剂,并对术后视力、免疫排斥反应及并发症等进行观察。结果　随访时间15~28个月,平均24个月。(1)视力:术后6个月,A、B组脱盲率分别为95% 和88% (P=0 582);术后12个月分别为84% 和38% (P=0 006);术后24个月分别为63% 和7% (P=0 .016)。( 2 )免疫排斥:A、B组角膜缘干细胞(LSC)排斥分别为9只眼(47% )、8只眼(50% ) (P=1 000);植片内皮型免疫排斥分别为6只眼(32% )、11只眼(69% ) (P=0. 044)。不同时间段两组内皮排斥比较,差异无统计学意义(P>0. 05)。(3)术后并发症:角膜上皮缺损A组2只眼(11% ),B组7只眼(44% ) (P=0 .049);前房积血A组2只眼( 11% ),B组8只眼(50% ) (P=0.022);术后低眼压A组1只眼(5% ),B组6只眼(38% ) (P=0

Combined penetrating keratoplasty with keratolimbal allograft transplantation in the treatment of severe corneal burns

Objective To study the clinical results of combined penetrating keratoplasty with keratolimbal allograft transplantation in the treatment of severe corneal burns. Methods The present study consisted of 35 eyes (34 patients) with full thickness corneal opacities and extensive corneal conjunctivalization after severe corneal burns. The duration between the injury and the time of presentation ranged from four months to 23 years. Group A: Combined penetrating keratoplasty (PK) with annular keratolimbal allograft transplantation (KLAT) was performed in 19 eyes(18 patients). Group B: Total PK with a scleral rim was performed in 16 eyes (16 patients). Post-operative visual acuity, intraocular pressure,graft rejection and complications were monitored. The average follow up time was 24 (range from 15 to 28) months. Results (1) Vision: The number of eyes that obtained best corrected visual acuity >0.05 was 18 eyes (95%) in group A and 14 eyes (84%) in group B at 6 months postoperatively ( P =0.582); 16 eyes (88%) in group A and 6 eyes (38%) in group B at 12 months ( P =0.006); 12 eyes (63%) in group A and 3 (7%) in group B at 24 months ( P =0.016). (2) Graft rejection: Nine allografts (47%) in group A and 8 grafts (50%) in group B developed limbal stem cell rejection ( P =1.000); 6 allografts (32%) in group A and 11 allografts (69%) in group B developed endothelium rejection ( P =0.044). The difference of endothelium rejection rate between group A and B was not significant at different times postoperatively. (3)Complications: Corneal epithelium defect occurred in 2 eyes (11%) in group A and 7 (44%) eyes in group B ( P =0.049); hyphema occurred in 2 eyes (11%) in group A and 8 eyes (50%) in group B ( P =0.022); hypotony occurred in 1 eye (5%) in group A and 6 eyes (38%) in group B ( P =0.032). Conclusions PK combined with KLAT is an effective treatment for severe corneal burns at a late stage irrespective of the etiology. This procedure can restore visual function in severely damaged eyes. Patients treated with PK combined with KLAT show less complication and better prognosis as compared with patients treated with total PK with a scleral rim.