角膜内皮失代偿患者302例临床分析
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摘要
目的探讨近10年角膜内皮失代偿患者的病因、手术方式、人口学特征及其随时间的变化规律。方法回顾分析2008年1月～2017年12月在本科因角膜内皮失代偿行角膜移植术患者的临床资料,共计302例(310眼),其中男性159例(165眼)、女性143例(145眼)。应用SPSS 22.0软件对患者资料进行统计学分析。结果病因包括:白内障手术101例(103眼,33.2%)、青光眼60例(62眼,20%)、眼外伤53例(55眼,17.7%)、玻璃体视网膜手术27例(27眼,8.7%)、Fuchs角膜内皮营养不良24例(25眼,8.1%)、病毒性角膜炎14例(15眼,4.8%)、真菌性角膜炎12例(12眼,3.9%)、先天性遗传性角膜内皮营养不良11例(11眼,3.6%)。所有患者310眼中,行穿透性角膜移植术(PKP)的,为131眼(42.3%);行角膜内皮移植术(EK)的,为179眼(57.7%)。角膜内皮移植患者中,行后弹力层剥除角膜内皮移植术术(DSEK)的,为168眼(54.2%);行深板层角膜内皮移植术(DLEK)的,仅有11眼(3.5%)。前5年PKP及DSEK构成比分别为54.9%、38.3%,后5年PKP下降为28.4%,而DSEK则上升为71.6%;角膜移植术式构成比变化差异具有统计学意义(χ~2=28.36,P<0.001)。结论 2008～2017年白内障手术为角膜内皮失代偿的首位病因; DSEK已超过PKP成为治疗角膜内皮失代偿的首选术式。
Objective To explore the causes,surgical patterns,age and gender distributions of patients with corneal endothelial decompensation and their changes with time. Methods The medical records of patients with corneal endothelial decompensation hospitalized in Eye Ear Nose and Throat Hospital of Fudan University during Jan.2008 to Dec. 2017 were reviewed respectively. Three hundred and two cases(310 eyes) were enrolled,including 159 male cases(165 eyes) and 143 female cases(145 eyes). Results The most common cause was cataract surgery(101 cases,103 eyes,33.2%),followed by glaucoma(60 cases,62 eyes,20%),ocular trauma(53 cases,55 eyes,17.7%),vitreoretinal surgery(27 cases,27 eyes,8.7%),Fuch's corneal endothelial dystrophy(24 cases,25 eyes,8.1%),viral keratitis(14 cases,15 eyes,4.8%),fungal keratitis(12 cases,12 eyes,3.9%) and congenital hereditary endothelial dystrophy(CHED,11 cases,11 eyes,3.6%). Penetrating keratoplasty(PKP) was performed in 131 eyes(42.3%),while endothelial keratoplasty(EK) was performed in 179 eyes(57.7%),including 11 eyes(3.5%) with deep lamellar endothelial keratoplasty(DLEK) and 168 eyes(54.2%) with Descemet stripping endothelial keratoplasty(DSEK). The proportion of DSEK increased significantly from 38.3%(during 2008～2012)to 71.6%(during 2013～2017); however,the proportion of PKP decreased from 54.9% to 28.4%(P<0.001).Conclusions Cataract surgery was the most common cause for corneal endothelial decompensation. DSEK has surpassed PKP as the first surgical choice of corneal endothelial decompensation with time.
Objective To explore the causes,surgical patterns,age and gender distributions of patients with corneal endothelial decompensation and their changes with time. Methods The medical records of patients with corneal endothelial decompensation hospitalized in Eye Ear Nose and Throat Hospital of Fudan University during Jan.2008 to Dec. 2017 were reviewed respectively. Three hundred and two cases(310 eyes) were enrolled,including 159 male cases(165 eyes) and 143 female cases(145 eyes). Results The most common cause was cataract surgery(101 cases,103 eyes,33.2%),followed by glaucoma(60 cases,62 eyes,20%),ocular trauma(53 cases,55 eyes,17.7%),vitreoretinal surgery(27 cases,27 eyes,8.7%),Fuch's corneal endothelial dystrophy(24 cases,25 eyes,8.1%),viral keratitis(14 cases,15 eyes,4.8%),fungal keratitis(12 cases,12 eyes,3.9%) and congenital hereditary endothelial dystrophy(CHED,11 cases,11 eyes,3.6%). Penetrating keratoplasty(PKP) was performed in 131 eyes(42.3%),while endothelial keratoplasty(EK) was performed in 179 eyes(57.7%),including 11 eyes(3.5%) with deep lamellar endothelial keratoplasty(DLEK) and 168 eyes(54.2%) with Descemet stripping endothelial keratoplasty(DSEK). The proportion of DSEK increased significantly from 38.3%(during 2008～2012)to 71.6%(during 2013～2017); however,the proportion of PKP decreased from 54.9% to 28.4%(P<0.001).Conclusions Cataract surgery was the most common cause for corneal endothelial decompensation. DSEK has surpassed PKP as the first surgical choice of corneal endothelial decompensation with time.
引文
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[9]洪颖,殷英霞,靳瑛,等.白内障手术后角膜内皮失代偿原因分析——不可忽视的原发角膜内皮病变[J].中国实用眼科杂志,2012,30(9):1071-1074.
[10] CHEN M J,LIU C J,CHENG C Y,et al. Corneal status in primary angle-closure glaucoma with a history of acute attack[J]. J Glaucoma,2012,21(1):12-16.
[11]张钰,张纯.小梁切除术对角膜内皮功能的影响[J].眼科新进展,2005,25(6):550-552.
[12]刘丽,王永恒,任凤杰,等.眼球挫伤对角膜内皮细胞的影响[J].中华眼外伤职业眼病杂志,2013,35(12):884-886.
[13]程钧,翟华蕾,王君怡,等.角膜后部真菌感染的临床特点和治疗策略[J].中华眼科杂志,2017,53(10):758-765.
[14] KEENAN T D,JONES M N,RUSHTON S,et al. Trends in the indications for corneal graft surgery in the United Kingdom:1999through 2009[J]. Arch Ophthalmol,2012,130(5):621-628.
[15] LIU Y C,ALVAREZ PARAZ C M,CAJUCOM-UY H Y,et al.Risk factors for donor endothelial loss in eye bank-prepared posterior lamellar corneal tissue for descemet stripping automated endothelial keratoplasty[J]. Cornea,2014,33(7):677-682.
[16] HAYASHI K,HAYASHI H,NAKAO F,et al. Risk factors for corneal endothelial injury during phacoemulsification[J]. J Cataract Refract Surg,1996,22(8):1079-1084.
[17] VAN CLEYNENBREUGEL H,REMEIJER L,HILLENAAR T.Cataract surgery in patients with Fuchs'endothelial corneal dystrophy:when to consider a triple procedure[J]. Ophthalmology,2014,121(2):445-453.
[2]张朝然,徐建江. 117例穿透性角膜移植患者的病因分析[J].中国眼耳鼻喉科杂志,2005,5(1):31-33.
[3]王艳,徐建江,孙兴怀.大泡性角膜病变病因分析[J].中国眼耳鼻喉科杂志,2005,5(6):363-364.
[4]谢立信,王富华,史伟云. 1997至2002年山东省眼科研究所穿透性角膜移植术的原因分析[J].中华眼科杂志,2006,42(8):704-708.
[5] DARLINGTON J K,ADREAN S D,SCHWAB I R. Trends of penetrating keratoplasty in the United States from 1980 to 2004[J].Ophthalmology,2006,113(12):2171-2175.
[6] PARK C Y,LEE J K,GORE P K,et al. Keratoplasty in the United States:a 10-year review from 2005 through 2014[J].Ophthalmology,2015,122(12):2432-2442.
[7] WANG J Y,XIE L X,SONG X S,et al. Trends in the indications for penetrating keratoplasty in Shandong,2005-2010[J]. Int J Ophthalmol,2011,4(5):492-497.
[8] LI J Y,MANNIS M J. Eye banking and the changing trends in contemporary corneal surgery[J]. Int Ophthalmol Clin,2010,50(3):101-112.
[9]洪颖,殷英霞,靳瑛,等.白内障手术后角膜内皮失代偿原因分析——不可忽视的原发角膜内皮病变[J].中国实用眼科杂志,2012,30(9):1071-1074.
[10] CHEN M J,LIU C J,CHENG C Y,et al. Corneal status in primary angle-closure glaucoma with a history of acute attack[J]. J Glaucoma,2012,21(1):12-16.
[11]张钰,张纯.小梁切除术对角膜内皮功能的影响[J].眼科新进展,2005,25(6):550-552.
[12]刘丽,王永恒,任凤杰,等.眼球挫伤对角膜内皮细胞的影响[J].中华眼外伤职业眼病杂志,2013,35(12):884-886.
[13]程钧,翟华蕾,王君怡,等.角膜后部真菌感染的临床特点和治疗策略[J].中华眼科杂志,2017,53(10):758-765.
[14] KEENAN T D,JONES M N,RUSHTON S,et al. Trends in the indications for corneal graft surgery in the United Kingdom:1999through 2009[J]. Arch Ophthalmol,2012,130(5):621-628.
[15] LIU Y C,ALVAREZ PARAZ C M,CAJUCOM-UY H Y,et al.Risk factors for donor endothelial loss in eye bank-prepared posterior lamellar corneal tissue for descemet stripping automated endothelial keratoplasty[J]. Cornea,2014,33(7):677-682.
[16] HAYASHI K,HAYASHI H,NAKAO F,et al. Risk factors for corneal endothelial injury during phacoemulsification[J]. J Cataract Refract Surg,1996,22(8):1079-1084.
[17] VAN CLEYNENBREUGEL H,REMEIJER L,HILLENAAR T.Cataract surgery in patients with Fuchs'endothelial corneal dystrophy:when to consider a triple procedure[J]. Ophthalmology,2014,121(2):445-453.