【摘要】 目的分析穿透性角膜移植术后植片哆开的发生原因、时间、伤情与预后的关系等。方法收集山东省眼科研究所1993年～2004年间所行穿透性角膜移植(penetratingkeratoplasty,PKP)术3150例中发生角膜植片哆开的27例患者。详细记录患者角膜植片哆开的原因、时间、受伤程度、治疗、伤情与预后的关系等情况。结果(1)发生原因:碰伤11例,拳击伤9例,异物击伤5例,手指戳伤2例。(2)发生时间:70.4%的患者发生在术后两年内,其余散在分布,最短时间15天,最长时间12年。(3)受伤程度:角膜裂伤均沿角膜植片植床缝合处断开。5例植片哆开范围在1～3个钟点,16例在4～6个钟点之间,5例在7～9个钟点之间,1例植片完全脱落。植片哆开范围<6个钟点的患者共10例,4例发生了晶状体、虹膜及玻璃体脱出,植片哆开范围≥6个钟点的患者16例,均发生了晶状体、虹膜及玻璃体脱出。(4)治疗:10例单纯行角膜植片重缝术,11例行角膜植片重缝+前玻切术,5例联合视网膜复位术,1例眼内容剜除术。(5)伤情与预后:2例植片哆开范围小且未发生眼内容脱出的患者视力较伤前提高,其余视力均有不同程度下降。随着角膜植片哆开范围的增加,患者视力下降程度加重。结论PKP术后角膜植片哆开主要由外伤造成,术后两年内为高发期,眼部受伤的严重程度与预后密切相关。更多还原

【Abstract】 Objective To describe the causes, time, extent of wound and outcome of dehiscence occurring in patients who had penetrating keratoplasty (PKP). Methods Between 1993 and 2004, 27 corneal transplant patients sustained traumatic wound dehiscence and were treated at our hospital which performed 3150 cases PKP in 12 years. We recorded the causes, time, characteristics, the extent of wound, treatment, and outcome. Results (1) The casuse of dehiscence: All of the patients suffered trauma. Eleven eyes were trauma- tized accidentally by blunt wound, 9 eyes as a result of intentional assault by fist, 5 eyes by accidental object, 2 eyes by finger poke. (2) The time of trauma: Dehiscence occurred from 15 days to 12 years. 70.4% patients developed wound dehiscence within 2 years. (3) The extent of wound: All corneal dehiscence occurred at the graft-host junction. The extent of wound dehiscence was 1~3 o’clock in 5 eyes, 4~6 o’clock in 16 eyes, 7~9 o’clock in 5 eyes, 12 o’clock in 1 eye. Four patients developed lens, iris and vitreous pushed out in 10 patients whose wound extent<6 o’clock. Sixteen patients developed lens, iris and vitreous pushed out whose wound extent ≥ 6 o’clock. (4)Treatment: Ten patients were treated with wound suture. Eleven patients combined with anterior vitrectomy. Five patients combined with retinal detachment surgery. One patient was performed evis- ceration as retina loss and no light perception. (5)Wound and prognosis: VA (visual acuity) increased than pre- trauma in 2 patients whose extent of wound was small. Most of VA is decreased than pre-trauma. With the increasing of traumatic extent, decrease of VA was serious. Conclusions The main cause of graft dehiscence is trauma. The high risk period is the first 2 years after PKP. The extent of wound impact the prognosis directly.更多还原