摘要
目的探讨角膜混浊合并白内障患者行穿透角膜移植(PKP)联合白内障囊外摘出术(ECCE)及人工晶状体(IOL)植入术的手术时机和效果。方法采用3种手术方式治疗此类患者67例67眼,其中:Ⅰ组14例行三联手术(PKP+ECCE+IOL);Ⅱ组19例行两联手术(PKP+ECCE),1年后行IOL植入;Ⅲ组34例行单纯PKP,1年后行白内障超声乳化人工晶状体植入术(PE+IOL)。结果平均随访8.8个月,Ⅰ、Ⅱ、Ⅲ三组植片成活率分别为85.7%、73.7%、100%。Ⅰ组患者术后屈光度差异大,平均球镜值(5.12±2.53)D,平均散光度(3.23±1.55)D。Ⅱ组患者术后前房反应较大,17例患者发生虹膜后粘连,8例患者发生一过性高眼压。Ⅲ组患者无上述并发症发生,术后屈光度差异小,平均球镜值(1.25±0.90)D,平均散光度(2.75±1.25)D。且角膜内皮细胞数术前为(1 515.54±302.91)mm2,术后为(1 368.32±280.11)mm2,平均损失率为11.0%。结论此类患者的不同术式结果差别较大,不适合一律行三联手术。先行PKP,1年后根据新的角膜曲率二期行PE+IOL术可获满意效果。
Objective To explore the surgical methods and results of penetrating keratoplasty （PKP） and extracapsular cataract extraction （ECCE）with intraocular lens （IOL） implantation for corneal opacity associated with cataract. Methods Sixty-seven eyes of 67 patients were treated with three surgical methods including triple procedures （ PKP ＋ ECCE ＋ IOL） in 14 eyes （group Ⅰ ）,combined procedure （PKP ＋ ECCE） followed by IOL implantation one year later in 19 eyes （group Ⅱ ）,and PKP followed by PE ＋ IOL one year later in 34 eyes （ group Ⅲ ）. Mean follow-up time was 8.8 months. Results Graft survival in three groups were 85.7% ,73.7% and 100% respectively. Postoperative refractive error in group I was prominent,and the mean spherical value was 5. 12 ＋ 2.53 D and mean cylindrical value was 3.23 ＋ 1.55 D. Postoperative reaction in anterior chamber was distinctive in group Ⅱ , iris posterior synechia in 17 eyes and temporary intraocular hypertension in 8 eyes. No complications mentioned above occurred in group Ⅲ , and postoperative refractive error was lower with the mean spherical value 1.25 ＋ 0.90 D and mean cylindrical value 2.75 ＋ 1.25 D. The corneal endothelium of preoperative was 1 515.54 mm^2 ＋ 302.91 mm^2 and 1 368.32 mm^2 ＋ 280. 11 mm^2 in postoperation, the mean rate of losing cells was 11.0%. Conclusion Different surgical combinations result in varied outcome. The triple procedure was not suitable without exception. Satisfied outcome can result from PKP followed by secondary PE ＋ IOL based on new corneal curvature.
出处
《眼科研究》
CSCD
北大核心
2005年第6期647-649,共3页
Chinese Ophthalmic Research
