某三级甲等医院眼科2015 - 2019年角膜移植手术病因及术式变化分析

李燕; 梅丽娜; 吕秀珊; 杜翠梅; 陈雯; 黄一飞; 王丽强

doi:10.3969/j.issn.2095-5227.2021.11.004

某三级甲等医院眼科2015 - 2019年角膜移植手术病因及术式变化分析

Changes in causes and surgical techniques of keratoplasty in a grade A tertiary hospital from 2015 to 2019: A retrospective analysis of 722 cases

摘要

摘要:
背景角膜疾病是常见的可逆性致盲疾病，角膜移植手术是治疗角膜盲的主要方法，是目前成功率最高的移植手术，根据手术方式，可分为穿透性角膜移植术(penetrating keratoplasty，PKP)、板层角膜移植术(lamellar keratoplasty，LKP)、深板层角膜移植术(deep lamellar keratoplasty，DLKP)和角膜内皮移植术(endothelia keratoplasty，EKP)。随着角膜移植手术技术的不断发展及显微手术精密性的增加，成分角膜移植手术方式逐渐代替PKP应用于临床中。
目的探讨患者接受角膜移植手术的病因、手术方式及其变化趋势。
方法对2015年1月- 2019年12月于本院眼科行角膜移植手术患者的人口学资料、手术原因及手术方式进行回顾性分析。
结果 2015年1月-2019年12月本院接受角膜移植手术患者共计667例722眼。其中，男性451例(67.6%)492眼，女性216例(32.4%)230眼，年龄最小4个月，最大92岁，平均(43.8±20.1)岁，18 ~ 59岁的中青年患者453例(67.9%)。患者来自全国各地，北京市周边省市地区265例，占39.7%。病因分析：最常见为感染性角膜病变共167眼(23.1%)，其中以病毒性角膜炎最多共79眼(47.4%)；其次为再次手术111眼(15.3%)、角膜白斑108眼(15.0%)、眼外伤98眼(13.6%)、圆锥角膜83眼(11.5%)、大疱性角膜病变79眼(10.9%)、角膜变性与营养不良51眼(7.1%)、角膜肿瘤及其他25眼(3.4%)。5年中眼外伤比例增长最明显。所有角膜移植手术中，PKP 227眼(31.4%)，LKP 190眼(26.3%)，DLKP 182眼(25.2%)，EKP 73眼(10.1%)，各术方式的手术量趋于平衡且每年手术总量变化不大，PKP稍有下降趋势，LKP和EKP有上升趋势，DLKP趋于平稳。
结论感染性角膜炎是角膜移植手术的主要原因，PKP仍为主要的手术方式，LKP手术量增加，EKP普遍应用于临床中。

Abstract:
Background Corneal blindness is a common seen reversible blindness which can be managed with transplantation of a healthy donor cornea. Corneal transplantation is an organ transplantation with the highest success rate, and it can be classified as penetrating keratoplasty, deep lamellar keratoplasty, lamellar keratoplasty, endothelia keratoplasty according to different operation procedures. With the development of surgical techniques, instruments and microscopes, component keratoplasty is applied in clinical practice.
Objective To analyze the changes in causes and surgical techniques of corneal transplantation.
Methods The demographic data, causes and operation modes of 667 patients who underwent keratoplasty in department of ophthalmology in our hospital from January 1, 2015 to December 31, 2019 were analyzed retrospectively.
Results Totally 722 keratoplasties were performed on 667 patients. Of the 667 cases, 451 cases (67.6%) were male (492 eyes) and 216 cases (32.4%) were female (230 eyes). The average age of patients at time of surgery was (43.8±20.1) years, ranging from 4 months to 92 years, and 453 cases (67.9%) aged from 18 to 59 years. Patients came from all over the country, including 265 cases in provinces and cities around Beijing, accounting for 39.7% of the whole sample. The leading indications for corneal transplantation were keratitis in 167 eyes (23.1%), including 79 eyes (47.4%) were associated with virus; followed by reoperation in 111 eyes (15.3%), corneal scar in 108 eyes (15.0%), injury in 98 eyes (13.6%), keratoconus in 83 eyes (11.5%), bullae keratopathy in 79 eyes (10.9%), corneal dystrophy and degeneration in 51 eyes (7.1%), corneal dermoid and others in 25 eyes (3.4%). Of all the corneal transplant surgery, 227 (31.4%) eyes underwent penetrating keratoplasty (PKP), 190 (26.3%) eyes were lamellar keratoplasty (LKP) ,182 (25.2%) eyes were deep lamellar keratoplasty (DLKP), and 73 (10.1%) eyes were endothelia keratoplasty (EKP). The number of PKP was decreasing, while LKP and EKP increased.
Conclusion Infection keratitis is the first indication for keratoplasty, PKP is always the leading surgery mode, DLKP is tend to stable. LKP demonstrates an increasing trend and EKP has been applied in clinical practice.

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