目的探讨深板层角膜移植联合自体角膜层间垫片术治疗角膜穿孔的临床效果。
方法采用系列病例观察研究，收集2017年1月至2018年8月于河南省人民医院眼科就诊的角膜穿孔患者14例14眼，所有患者均行深板层角膜移植术，术中取自体角膜基质片填垫于角膜穿孔处。分别于术后第1、7、14天，第1、3、6、9、12个月记录患者视力、眼压、角膜上皮愈合时间、感染是否复发、角膜植片及前房情况；术后第1、6、12个月行眼前节OCT检查，查看角膜植床植片层间结构及前房与虹膜结构。根据术后1年的随访情况评估手术的安全性和有效性。
结果术后角膜上皮愈合时间为2～4 d，平均(3.01±0.59)d。术后第1天，所有患者前房形成良好，无双前房出现。角膜植片与植床贴服良好，植片轻度水肿。术后2周，无角膜感染溃疡复发，14例患者角膜溃疡愈合，前房形成良好。术后3个月，角膜移植片透明，眼前节OCT示角膜植床植片层间贴附良好，前房情况稳定。术后1年，9眼最佳矫正视力≥0.3，所有患者视力显著提高，术后未见难治性青光眼出现。
结论深板层角膜移植联合自体角膜层间填垫可以安全、有效地治疗角膜穿孔。
ObjectiveTo study the clinical outcome of lamellar keratoplasty combined with autogenous corneal stromal padding for treatment of corneal perforation.
MethodsAn observational case series study was conducted.A total of 14 patients (14 eyes) with corneal perforation underwent lamellar keratoplasty in Henan Provincial People's Hospital from January 2017 to August 2018 were collected.During the operation, the corneal stromal autograft was taken to pad the corneal perforation.Visual acuity, intraocular pressure, corneal epithelial healing time, infection recurrence, and the status of corneal graft and anterior chamber were recorded on the 1st, 7th, 14th day, 1st, 3rd, 6th, 9th and 12th month after operation.OCT examination of anterior segment was performed at 1 month, 6 and 12 months postoperatively to observe the interlamellar structure of corneal implantation bed and stromal graft, anterior chamber and iris.The safety and effectiveness of the operation were evaluated according to the 1-year follow-up.The study protocol adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2019[18]). Written informed consent was obtained from each patient prior to entering the study cohort.
ResultsThe healing time of corneal epithelium was 2-4 days after operation, (3.01±0.59) days on average.At one day after surgery, all patients had normal anterior chamber depth without aqueous leak and no double chamber was observed.The corneal grafts attached to the implantation bed well and showed mild to moderate edema.There was no recurrence of corneal infection ulcer two weeks after operation, and the corneal ulcer was healed and anterior chamber was well formed in 14 patients.The corneal graft was transparent, and the anterior segment OCT image showed corneal implant bed and graft were well attached, and the anterior chamber depth was normal three months after operation.The best corrected visual acuity of 9 eyes was more than 0.3 one year after operation, and the vision acuity of the 14 patients improved obviously, and no refractory glaucoma occurred after operation.
ConclusionsLamellar keratoplasty combined with autogenous corneal stromal padding is a safe and effective surgical procedure for treating corneal perforation.
王璐璐,张月琴,余晓菲,等. 深板层角膜移植联合自体角膜层间垫片术对角膜穿孔的临床应用价值[J]. 中华实验眼科杂志,2021,39(02)：144-148.
DOI:10.3760/cma.j.cn115989-20190927-00418版权归中华医学会所有。
未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。
除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。
文档即答
智问智答
机器翻译
你好，我可以帮助您更好的了解本文，请向我提问您关注的问题。
