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目的 为了使全角膜穿透性移植术 (TPK)后移植片混浊的病人复明 ,再次行部分穿透性角膜移植术 (PPK) ,观察疗效。方法 对 1 8例TPK术后出现移植片混浊的连续病例 ,再行PPK (甚或多次PPK)治疗 ,观察和分析术后变化。结果 PPK后移植片透明率 55. 56 % ( 1 0 /1 8) ,视力 0 . 1及以上者 1 2例 ( 6 6 . 6 7% )。第一次PPK后 6例眼内压升高 ( 33 .33% ) ,UBM检查PAS及房角关闭 >1 /2周者 8例 ( 6 1 . 54% ) ,均较术前明显降低 (P <0 . 0 1 )。与移植片混浊关系密切的因素有 :原发病 ,角膜新生血管 ,PAS及房角关闭 >1 /2周 ,术前或术后行睫状体光凝术 ,术中联合小梁切除术等。结论 TPK后移植片混浊的病人可再次行PPK复明 ,但术后视力改善、移植片生存质量、术后青光眼发生、排斥反应等问题均需密切随访。术前纠正预先存在的危险因素 ,术中避免过多的手术干预 (尤其联合小梁切除术 ) ,术前、术后避免睫状体光凝术 ,可提高TPK后再次PPK成功率。
Objectives To reconstruct the opacified patients after total keratoplasty (TPK) transplants, some penetrating keratoplasty (PPK) were performed again to observe the curative effect. Methods A total of 18 consecutive cases of graft opacification after TPK were treated with PPK (or PPK) or more. Postoperative changes were observed and analyzed. Results After PPK transplanting, the transparence rate was 55.56% (10/18), and the visual acuity was 0.1 or higher in 12 cases (6.67%). The intraocular pressure was increased in 6 cases (33.33%) after the first PPK, 8 cases (6.15%) in UBM and P> <0. 0 1). Closure of the factors associated with the opacification of the graft are: primary disease, corneal neovascularization, PAS and angle closure> 1/2 weeks, preoperative or postoperative ciliary body photocoagulation, intraoperative and trabeculectomy . Conclusions The patients with TPK posterior capsular opacification can reopen PPK, but the follow - up should be closely followed after the improvement of visual acuity, the quality of life of the graft, the occurrence of postoperative glaucoma and rejection. Preoperative correction of pre-existing risk factors, surgery to avoid excessive surgical intervention (especially with trabeculectomy), preoperative and postoperative avoid ciliary body photocoagulation, can improve PPK success rate after TPK.