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目的:探讨深板层角膜移植术治疗角膜疾病的临床应用效果及手术适应症。方法:总结2001年以来行深板层角膜移植术的患者共42眼,其中蚕蚀性角膜溃疡13眼,单疱病毒性角膜炎后深层角膜斑翳4眼,真菌性角膜溃疡5眼,细菌性角膜溃疡1眼,角膜带状变性6眼,斑块状角膜营养不良4眼,角膜热烧伤6眼,角膜化学伤3眼。术后予以糖皮质激素眼液+1%环胞霉素A眼液滴眼。同时观察视力、角膜植片及术后并发症的情况。结果:40眼角膜植片愈合良好,创面光滑,逐渐恢复透明。1眼因外伤致角膜上皮缺损延期愈合;1眼因真菌性角膜溃疡复发改行全角膜移植术,其余眼表保持稳定,平均随诊43.8个月,视力均有不同程度提高。除角膜层间新生血管及上皮型排斥反应外,未出现明显基质型排斥反应。结论:近年来深板层角膜移植术发展迅速。它是一种成份角膜移植术,不但能获得与穿透角膜移植相似的透明性和视力恢复效果,还可减少术后内皮型排斥反应的发生及眼内手术并发症的危险,达到治疗和增视的双重目的。但对角膜内皮细胞的形态和数量很难做出正确的评价的患眼应选择穿透性角膜移植术。
Objective: To investigate the clinical effects and surgical indications of deep lamellar keratoplasty in the treatment of corneal diseases. Methods: A total of 42 patients with deep lamellar keratoplasty since 2001, including 13 cases of Mooren ’s ulcer, 4 cases of deep keratitis after herpes simplex keratitis, 5 eyes of fungal corneal ulcer, 1 corneal ulcer, 6 corneal degeneration, 4 corneal dysplasia, 6 corneal thermal burns and 3 corneal chemical injuries. Postoperative glucocorticoid eye drops + 1% cyclosporin A eye drops. At the same time observe the vision, corneal graft and postoperative complications. Results: Forty corneas of the cornea healed well, the wound was smooth, and gradually recovered to be transparent. One case of corneal epithelial defects due to trauma was delayed healing; one case of fungal corneal ulcer recurrence of total corneal transplantation, the rest of the ocular surface remained stable, with an average follow-up of 43.8 months, visual acuity were improved to varying degrees. In addition to corneal neovascularization and epithelial rejection, there was no obvious matrix-type rejection. Conclusion: In recent years, deep lamellar keratoplasty has developed rapidly. It is a component of keratoplasty, not only can get the same transparency and vision recovery effect as penetrating keratoplasty, but also reduce the incidence of postoperative endocrine rejection and complications of intraocular surgery to achieve therapeutic and Depending on the dual purpose. However, corneal endothelial cells in the shape and quantity is difficult to make a correct assessment of the affected eye should choose penetrating keratoplasty.