摘要
目的探讨穿透性角膜移植术后创口裂开的特点、治疗方法及对视功能的影响.方法选择1997年7月至2003年6月于中山眼科中心就诊的32例穿透性角膜移植术后创口裂开的患者,根据眼球裂伤程度采用创口缝合或联合虹膜切除、晶状体切除、人工晶状体摘出、前段玻璃体切除、同期或Ⅱ期玻璃体切除或联合眼内气体和硅油填充视网膜脱离复位术等处理创口裂开及其并发症,随访观察术后视力、植片透明度、眼压及眼球后段结构的变化.结果术后24例患者保留了眼球,8例患者眼球萎缩.8例缝线断裂或松脱患者,术后6例视力提高,角膜植片均透明,眼压正常,未出现玻璃体出血及脉络膜、视网膜脱离.14例创口裂伤范围1/4～1/2周的患者,术后8例视力下降,11例角膜植片混浊,5例眼压异常（降低或升高）.8例创口裂伤范围1/2～3/4周患者,术后7例视力下降,5例角膜植片混浊,7例眼压异常（降低或升高）,4例玻璃体出血,4例脉络膜、视网膜脱离.2例创口裂伤范围≥3/4周的患者,术后均无光感,角膜植片混浊,眼压降低（眼球萎缩）,出现玻璃体出血及脉络膜、视网膜脱离.结论穿透性角膜移植术后创口稳定性和抗张能力差,较小的外力打击可引起破裂.穿透性角膜移植术后外伤性创口裂开常合并更严重的眼内容物脱出、玻璃体出血或脉络膜视网膜脱离,比普通眼外伤程度更严重、预后更差.
Objective To investigate the treatment of wound dehiscence after penetrating keratoplasty and to evaluate the influence of this complication on visual outcome. Methods A retrospective analysis of 32 patients with wound dehiscence that undergone penetrating keratoplasty in Zhongshan Ophthalmic Center from July 1997 to June 2003 was performed. All involved eyes were undergone wound repair with or without iris excision, lensectomy, intraocular lens removal, anterior vitrectomy and stage Ⅰ or stage Ⅱ pars plana vitrectomy with gas or silicone oil tamponade according to variable extents of host-graft wound dehiscence in individual patient. Visual outcome, transparency of graft, intraocular pressure and structure integrity of ocular posterior segment were followed-up for 6-18 months in details. These data were used to summarize the specific characteristics of this type of ocular trauma. Results Surgical outcomes were recorded as the following： 24 eyeballs were rescued, but eight of them developed phthisis bulbi. Broken or loose sutures of eyes were found in eight cases. Six cases achieved better visual acuity, all of which maintained clear grafts with normal intraocular pressure, and no vitreous hemorrhage or choroidal/retinal detachment occurred. In 14 eyes with wound dehiscence of 1/4-1/2 circle, eight cases ended with decreased visual acuity, 11 with grafts opacities, five with abnormal intraocular pressure （above or below the normal range）. In eight eyes with wound dehiscence of 1/2-3/4 circle, seven cases got decreased visual acuity, five with graft opacities, seven with abnormal intraocular pressure, four with vitreous hemorrhage, and four developing choroidal/retinal detachment. In the two eyes with wound dehiscence over 3/4 circle, beth resulted in graft opacities with no light perception. Vitreous hemorrhage, choroidal/retinal detachment as well as phthisis bulbi occurred due to low intraocular pressure. Conclusions After penetrating keratoplasty, the wounds of corneal graft show tectonic instability and poor resistance to tension. Traumatic wound dehiscence after penetrating keratoplasty often complicate with intraocular content herniation, vitreous hemorrhage, and choroidal/retinal detachment. Usually, this kind of trauma is from severe injuries and prognosis is worse than the common ocular trauma.
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2006年第1期12-16,共5页
Chinese Journal of Ophthalmology
关键词
角膜移植
穿透性
外科伤口裂开
预后
Keratoplasty, penetrating
Surgical wound dehiscence
Prognosis
