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目的分析穿透性角膜移植术后植片哆开的发生原因、时间、伤情与预后的关系等。方法收集山东省眼科研究所1993年～2004年间所行穿透性角膜移植(penetratingkeratoplasty,PKP)术3150例中发生角膜植片哆开的27例患者。详细记录患者角膜植片哆开的原因、时间、受伤程度、治疗、伤情与预后的关系等情况。结果(1)发生原因:碰伤11例,拳击伤9例,异物击伤5例,手指戳伤2例。(2)发生时间:70.4%的患者发生在术后两年内,其余散在分布,最短时间15天,最长时间12年。(3)受伤程度:角膜裂伤均沿角膜植片植床缝合处断开。5例植片哆开范围在1～3个钟点,16例在4～6个钟点之间,5例在7～9个钟点之间,1例植片完全脱落。植片哆开范围<6个钟点的患者共10例,4例发生了晶状体、虹膜及玻璃体脱出,植片哆开范围≥6个钟点的患者16例,均发生了晶状体、虹膜及玻璃体脱出。(4)治疗:10例单纯行角膜植片重缝术,11例行角膜植片重缝+前玻切术,5例联合视网膜复位术,1例眼内容剜除术。(5)伤情与预后:2例植片哆开范围小且未发生眼内容脱出的患者视力较伤前提高,其余视力均有不同程度下降。随着角膜植片哆开范围的增加,患者视力下降程度加重。结论PKP术后角膜植片哆开主要由外伤造成,术后两年内为高发期,眼部受伤的严重程度与预后密切相关。
Objective To analyze the causes, time, the relationship between the injury and the prognosis of penetrating keratoplasty after penetrating keratoplasty. Methods Totally 27 patients with penetrating keratoplasty (PDP) in 3150 cases underwent penetrating keratoplasty (PKP) in Shandong Eye Institute from 1993 to 2004 were collected. Detailed records of patients with corneal limbs Dove open reason, time, degree of injury, treatment, injury and prognosis of the relationship. Results (1) Causes: bruising in 11 cases, boxing injury in 9 cases, foreign body injuries in 5 cases, finger puncture in 2 cases. (2) Occurred time: 70.4% of patients occurred within two years after surgery, the rest of the scattered distribution, the shortest time of 15 days, the longest time of 12 years. (3) the degree of injury: corneal laceration along the corneal graft sutured off. 5 cases of apoplexy open range of 1 to 3 hours, 16 cases in 4 to 6 hours, 5 cases in 7 to 9 hours, 1 case of complete removal of the graft. There were 10 patients with a range of less than 6 hours after implantation. There were 4 patients with lens, iris and vitreous prolapse, and 16 patients with a range of ≥ 6 hours after implantation. All cases had lens, iris and vitreous prolapse. (4) Treatment: 10 cases of simple corneal graft resection, 11 cases of corneal graft resection plus anterior vitrectomy, 5 cases of combined retinal reattachment, 1 case of ocular content enucleation. (5) Injuries and prognosis: The visual acuity of 2 patients with small ducts and no prolapse of ocular contents increased compared with those before injury, and the rest of visual acuity decreased in varying degrees. With the increase of corneal implant duo open, patients with decreased vision loss. Conclusion Corneal PVP is mainly caused by trauma after PKP. The severity of eye injury is closely related to the prognosis in two years after PKP.