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背景:单纯药物治疗高危真菌性角膜溃疡效果不佳,目前穿透性角膜移植已是挽救眼球和视力的主要手段。目的:观察穿透性角膜移植治疗高危真菌性角膜溃疡的随访结果。设计、时间及地点:回顾性病例分析,于2000-01/2007-01在青岛大学医学院附属医院眼科完成。对象:选择在青岛大学医学院附属医院行穿透性角膜移植的高危真菌性角膜溃疡患者51例(51眼),其中12例穿孔,前房积脓35例,移植前合并白内障8例,合并青光眼5例。方法:移植前给予抗真菌联合抗细菌治疗,51例患者均在入院4d内完成了穿透性角膜移植,移植后局部和全身给予抗炎和抗真菌药物治疗,随访6～24个月。主要观察指标:观察移植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:①51例患者中18例随访6～12个月,25例随访13～18个月,8例随访19～24个月。②49例患者(占96.1%)成功地保存了眼球,48例(占94.1%)患者视力有不同程度提高。③移植后6例患者(占11.8%)真菌复发,其中4例药物治疗后治愈,2例摘除眼球;18例患者(占35.3%)植片发生排斥,其中13例经抗排斥治疗植片转为透明,5例因药物治疗无效而行二次穿透性角膜移植;4例患者(占7.84%)植片发生溃疡,其中3例治愈,1例因合并角膜内皮功能失代偿而行再次穿透性角膜移植;7例患者(占13.7%)继发青光眼,眼压均得到成功控制;6例患者(占11.8%)发生并发性白内障,其中3例行白内障摘除。其余患者移植后随访期间眼部情况稳定,植片保持透明。最终随访时,45例患者(占88.2%)角膜植片透明。结论:对于保守治疗无效的高危真菌性角膜溃疡患者,穿透性角膜移植是挽救眼球和视力的有效方法。
Background: Simple drug treatment of high-risk fungal corneal ulcers ineffective, penetrating keratoplasty has been the main means of saving the eye and vision. Objective: To observe the follow-up results of penetrating keratoplasty for treating high-risk fungal corneal ulcer. DESIGN, TIME AND SETTING: The retrospective case analysis was performed at the Department of Ophthalmology, Affiliated Hospital of Qingdao University Medical College from January 2000 to January 2007. PARTICIPANTS: Fifty-one patients (51 eyes) with penetrating keratoplasty and high-risk fungal corneal ulcer were selected from Affiliated Hospital of Qingdao University Medical College. Among them, 12 cases were perforation, 35 cases were empyema of anterior chamber, 8 cases were complicated with cataract before transplantation Glaucoma in 5 cases. Methods: Antifungal combined with antibacterial therapy was given before transplantation. All 51 patients completed penetrating keratoplasty within 4 days after admission. After transplantation, local and systemic anti-inflammatory and antifungal drugs were given. The patients were followed up for 6-24 months. MAIN OUTCOME MEASURES: Changes of visual acuity after transplantation and complications of fungal recurrence, graft rejection, secondary glaucoma and concurrent cataract were observed. Results: Among 51 patients, 18 cases were followed up for 6 to 12 months, 25 cases were followed up for 13 to 18 months, and 8 cases were followed up for 19 to 24 months. 49 patients (96.1%) successfully saved the eye, 48 patients (94.1%) have different degrees of visual acuity improved. 6 cases (11.8%) had fungal recurrence after transplantation, of which 4 cases were cured after drug treatment and 2 cases were enucleated; 18 cases (35.3%) had rejection of the graft, of which 13 cases were treated by anti-rejection For the transparent, 5 cases of secondary penetrating keratoplasty due to ineffective drug treatment; 4 cases (accounting for 7.84%) of the ulcers occurred in the ulcers, of which 3 cases were cured, 1 case due to corneal endothelial dysfunction and again Penetrating keratoplasty. Seven patients (13.7%) had secondary glaucoma and intraocular pressure was successfully controlled. Six patients (11.8%) had complicated cataract and three had cataract extraction. The rest of the patients had stable ophthalmic conditions during follow-up after transplantation, and the grafts remained clear. At final follow-up, 45 patients (88.2%) had a clear corneal graft. CONCLUSIONS: Penetrating keratoplasty is an effective method of salvage and visual acuity in patients with high-risk fungal corneal ulcers that are refractory to conservative treatment.