摘要目的 探讨依据蚕蚀性角膜溃疡病变形态施行不同形状的个体化板层角膜移植治疗的疗效.方法 回顾性系列病例研究.2008年1月至2011年6月中山眼科中心确诊的蚕蚀性角膜溃疡患者26例(31眼),根据溃疡累及周边部角膜范围和形态选择不同手术方式,分为新月形板层角膜移植组(14眼)、D形板层角膜移植组(7眼)、指环型板层角膜移植组(3眼)和全板层角膜移植组(7眼).术后随访6～36个月,评价患者术后视力、植片透明性、角膜散光变化规律以及并发症发生种类.结果 术后6个月最佳矫正视力为0.3～0.5的患者中,新月形板层角膜移植组3例,D形板层角膜移植组4例,全板层角膜组5例；最佳矫正视力为0.6～1.0患者新月形板层角膜移植组11例,D形板层角膜移植组3例,指环形板层角膜移植组3例,全板层角膜移植组2例.术后视力提高患者比例为54％,视力不变比例为40％,视力下降比例为6％.术后6个月指环形板层角膜移植组角膜散光最低,为(2.30±0.40)D;D形板层角膜移植组散光最高,为(3.70±1.03)D.术后主要并发症为植片上皮愈合不良4例(13％),蚕蚀性角膜溃疡复发2例(6％),缝线脓肿1例(3％),植片排斥4例(13％).结论 依据蚕蚀性角膜溃疡累及周边部角膜的部位和形态施行不同形状的板层角膜移植,可以在切除病灶的同时避免正常角膜组织的损失,减轻角膜散光程度,恢复患者的有效视力.

abstractsObjective To explore the indications, efficacy, and complications from different types of lamellar keratoplasty (LKP) for Mooren's corneal ulcers.Methods It was a retrospective case series study.Twenty-six patients (31 eyes) with Mooren's corneal ulcers underwent crescent LKP (14 eyes),D-shaped LKP (7 eyes),ring-shaped LKP (3 eyes),or total LKP (7 eyes) at Zhongshan Ophthalmic Center between January 2008 and June 2011.The selection of surgical procedures was based on the size and shape of the corneal ulceration.Best corrected visual acuity (BCVA),corneal graft clarity, astigmatism, and complications after the operation were studied during the follow-up period of 6-36 months.Results Patients with the BCVA between 0.3-0.5 after operation including,crescent LKP (3 eyes),D-shaped LKP (4 eyes),total LKP (5 eyes).Patients with the BCVA between 0.6-1.0 after operation including,crescent LKP (ll eyes),D-shaped LKP (3 eyes),ring-shaped LKP (3 eyes),total LKP (5 eyes).Visual acuity in 17eyes (54％) was improved after LKP,12 eyes (40％)remained the same,while 2 eyes (6％) decreased after operation.The mean corneal astigmatism in the ring-shaped graft group was 2.30±0.40 D,and 3.70±1.03 D in the D-shaped graft group 6 months after the operation.Postoperative complications included corneal epithelium defect in 4 eyes (13％),recurrence of Mooren's ulcer in 2 eyes (6％),suture-related corneal abscess in 1 eye (3％),and graft rejection in 4 eyes (13％).Conclusion LKP is effective in restoring the integrity of eyes with Mooren'sulcer.Designing the appropriate type of LKP based on the different shapes of corneal ulceration allows the removal of the corneal lesion and spares the maximum amount of normal tissue.Furthermore,a well-matched graft configuration can reduce surgically related astigmatism, and help to improve vision in most cases.