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目的分析儿童穿透性角膜移植术的病因、手术方式、植片透明率、排斥反应发生率及影响排斥反应的相关因素。设计回顾性病例系列。研究对象北京同仁眼科中心2008年1月至2013年12月穿透性角膜移植手术的12岁以下患儿81例(81眼)。方法根据年龄分为婴幼组(0~3岁,49眼)和儿童组(4岁~12岁,32眼)。术后平均随访(38.72±21.46)个月。回顾患者的病历资料。主要指标患者年龄、术前诊断、手术方式、术后植片透明度。结果病因主要为先天性角膜混浊占82.72%;后天外伤性占6.17%,后天非外伤性占11.11%(其中感染性角膜炎3.70%,圆锥角膜角膜3.70%、移植术后植片失败3.70%)。先天性角膜混浊在婴幼组占93.88%,儿童组占65.63%(P<0.01)。手术方式中单纯穿透性角膜移植术(PKP)占80.25%,其中婴幼组89.80%(44/49),儿童组75.00%(24/32)(P<0.05)。末次随访时总体植片透明率85.19%,其中婴幼组81.63%(40/49),儿童组90.63%(29/32)(P>0.05)。先天性因素者术后排斥率15.22%(7/46),后天性因素中活动性炎症导致角膜溃疡并穿孔(1/1)和植片失败进行再次角膜移植手术(3/3)的术后植片排斥率极高。结论 12岁以下儿童穿透性角膜移植的主要病因为先天性角膜混浊。虽然儿童角膜移植难度大,但仍具备一定的成功条件。儿童穿透性角膜移植植片存活率有所提高。
Objective To analyze the etiopathogenisis of children’s penetrating keratoplasty, the surgical method, the transparency rate of implants, the incidence of rejection and the related factors that influence the rejection. Design retrospective case series. Participants 81 patients (81 eyes) with penetrating keratoplasty under the age of 12 from January to December 2013 in Beijing Tongren Eye Center. The method was divided into infants and young children (0-3 years old, 49 eyes) and children group (4 years old to 12 years old, 32 eyes) according to the age. The patients were followed up for an average of (38.72 ± 21.46) months. Review the patient’s medical records. The main indicators of patient age, preoperative diagnosis, surgical methods, postoperative transparency of the graft. Results The main causes of congenital corneal opacity accounted for 82.72%; acquired trauma accounted for 6.17%, acquired non-traumatic 11.11% (infectious keratitis 3.70%, keratoconus 3.70%, graft failure 3.70%) . Congenital corneal opacity accounted for 93.88% in infants and young children, children accounted for 65.63% (P <0.01). Simple penetrating keratoplasty (PKP) accounted for 80.25% of the total, including 89.80% (44/49) for infants and young children and 75.00% (24/32) for children (P <0.05). At the final follow-up, the overall graft transparency was 85.19%, of which 81.63% (40/49) in infancy and 90.63% (29/32) in children (P> 0.05). Postoperative rejection rate of congenital factors were 15.22% (7/46). Postoperatively, active inflammation resulted in corneal ulcer with perforation (1/1) and graft failure after re-keratoplasty (3/3) Implant rejection rate is extremely high. Conclusion The main cause of penetrating keratoplasty in children under 12 years of age is congenital corneal opacity. Although children with corneal transplantation difficult, but still have some success conditions. Child penetrating keratoplasty survival rate has improved.