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目的探讨1997至2002年山东省眼科研究所6年间行穿透性角膜移植术(PKP)的原因及其变化。方法对1997年1月至2002年12月山东省眼科研究所的所有PKP病例进行回顾性调查,将PKP的原因分为10类:化脓性角膜炎、单纯疱疹病毒性角膜炎、圆锥角膜、大泡性角膜病变、角膜白斑、角膜破裂伤、角膜烧伤、再次PKP、遗传相关的角膜营养不良和角膜变性及其他。并且记录化脓性角膜炎的病原菌,大泡性角膜病变的病因,再次PKP的原发病和再次手术的原因。分析6年间PKP的原因及其变化情况。结果共调查1702例PKP患者。PKP的原因依次是化脓性角膜炎542例(31．9％)、单纯疱疹病毒性角膜炎299例(17．6％)、圆锥角膜219例(12．9％)、角膜白斑164例(9.6％)、大泡性角膜病变118例(6．9％)、角膜破裂伤105例(6．2％)、再次PKP 77例(4．5％)、角膜烧伤70例(4．1％)、遗传相关的角膜营养不良和角膜变性67例(3．9％)及其他41例(2．4％)。圆锥角膜(X2=26．399,P<0．001)和大泡性角膜病变(X2=11．4229,P<0．001)所占比例呈明显上升趋势,其他原因则无明显变化。化脓性角膜炎中真菌感染居首位(65．9％),6年来各病原菌所占比例无明显变化。多数大泡性角膜病变患者有内眼手术史,其中白内障手术最常见(76．3％)。再次PKP的原发病以角膜烧伤(24．7％)、单纯疱疹病毒性角膜炎(23．4％)及化脓性角膜炎(14．3％)为主,再次手术的原因主要是免疫排斥(61．0％)、植片感染(14．3％)及单纯疱疹病毒性角膜炎复发(10．4％)。结论感染性角膜病仍然是PKP的主要适应证,其中真菌感染为首位病因。圆锥角膜和大泡性角膜病变均呈明显上升趋势。
Objective To investigate the causes and changes of penetrating keratoplasty (PKP) in Shandong Provincial Institute of Ophthalmology from 1997 to 2002. Methods A retrospective study was conducted on all PKP cases from January 1997 to December 2002 in Shandong Province Eye Institute. The causes of PKP were divided into 10 categories: suppurative keratitis, herpes simplex keratitis, keratoconus, Vesicular keratopathy, Leukoplakia, Corneal rupture, Corneal burns, PKP again, Genetically related corneal dystrophy and corneal degeneration and others. And record the pathogens of suppurative keratitis, the cause of bullous keratopathy, again the primary disease of PKP and the reason of reoperation. Analyze the causes and changes of PKP in 6 years. Results A total of 1702 PKP patients were investigated. The causes of PKP were as follows: 542 cases (31.9%) of suppurative keratitis, 299 cases (17.6%) of herpes simplex virus keratitis, 219 cases (12.9%) of keratoconus, 164 cases ), Bullous keratopathy in 118 cases (6.9%), corneal rupture in 105 cases (6.2%), PKP again in 77 cases (4.5%) and corneal burns in 70 cases (4.1% , 67 cases (3.9%) of genetic related corneal dystrophy and corneal degeneration, and 41 cases (2.4%) of other cases. The proportion of keratoconus (X2 = 26.399, P <0.001) and bullous keratopathy (X2 = 11.4229, P <0.001) showed an obvious upward trend, while other causes showed no significant changes. Fungal infection in suppurative keratitis ranks first (65.9%), the proportion of pathogens in 6 years no significant change. Most patients with bullous keratopathy have a history of intraocular surgery, of which cataract surgery is the most common (76.3%). The primary pathogenesis of PKP was mainly corneal burns (24.7%), herpes simplex keratitis (23.4%) and suppurative keratitis (14.3%). The main reason for reoperation was mainly immune rejection (61.0%), infection of the graft (14.3%) and herpes simplex keratitis (10.4%). Conclusions Infectious keratopathy is still the major indication of PKP, with fungal infection as the leading cause. Keratoconus and bullous keratopathy showed a clear upward trend.