目的 比较深板层角膜移植和穿透性角膜移植术治疗圆锥角膜的临床效果。方法 2001年1月～2004年6月共收治圆锥角膜连续病例65例76眼，其中行深板层角膜移植术（指植床仅保留角膜后弹力层和内皮层）43眼，穿透性角膜移植术33眼，术后随访8个月～3年，比较不同术式下视力、角膜内皮计数、并发症、角膜植片透明等情况。结果 43眼行深板层角膜移植术后，裸眼视力≥0．4的25眼，33眼行穿透角膜移植术后，裸眼视力≥0．4的18眼，两组矫正视力均≥0．4，二者差异无统计学意义（X^2=0．089，P〉0．05）。深板层角膜移植术后角膜内皮计数平均（2870±340）个／mm^2，而穿透性角膜移植术后角膜内皮计数平均（2120±290）个／mm^2，二者差异有统计学意义（t=10．15，P〈0．05），深板层角膜移植术并发症为植床小穿孔4眼，后弹力层皱褶3眼，层间薄翳3眼，散光（〉2D）18眼；穿透性角膜移植术的并发症主要为植片排斥3眼，虹膜局限性前粘连5眼，散光（〉2D）15眼。两种方式术后均未见圆锥角膜复发，所有植片均透明。结论 深板层角膜移植治疗圆锥角膜可获得与穿透角膜移植一样的视力效果，且并发症较少，但与后者相比有一定局限性。
Objective To compare the clinical effectiveness between deep lamellar keratoplasty and penetrating keratoplasty for keratoconus. Methods Seventy-six eyes of 65 cases with keratoconus were enrolled from January,2001 to Jane, 2004. Deep lamellar corneal grafting was performed in 43 eyes and penetrat- ing corneal grafting in 33 eyes. The patients were followed-up for 6 months-3years. The vision acuity, counting of corneal endothelial cells, complications and the transparency of corneal graft in these two surgery types were evaluation and compared. Results The correct vision acuity was over 0.4 in 25 eyes in deep lamellar kerato- plasty group and 18 eyes in penetrating keratoplasty group without statistical difference between them （x2=0. 098, P〉0.05）.The mean corneal endothelial cells counting was （2870 ± 340） cells/mm^2 in deep lamellar kerato- plasty group and （2120 ± 290）cells/mm^2 in penetrating keratoplasty group with a significant difference between these two groups （t=10.15, P〈0.05）.The complications included perforation of grafting bed in 4 eyes, wrinkle of Descemet＇s membrane in 3 eyes, corneal intralamellar clouding in 3 eyes and astigmatism （〉2D） in 18 eyes in deep liminal group. Corneal graft reject was seen in 3 eyes, anterior synechia of iris in 5 eyes and astigmatism in 15 eyes in penetrating keratoplasty group. The grafts were clear in all eyes following the corneal transplantation and no recurrence of keratoconus was found during the follow-up period. Conclusions Deep lamellar keratoplasty has a similar outcome to penetrating keratoplasty in improving vision and less complications for keratoconus. However, deep lamellar keratoplasty is limited in the selection of indications for different types of keratoconus in comparison with penetrating keratoplasty.
Chinese Journal of Practical Ophthalmology