DCD角膜移植术后继发性青光眼的临床观察

Clinical Observation of Secondary Glaucoma after DCD Corneal Transplantation

摘要: 目的：探讨角膜移植术(keratoplasty, KP)后继发性青光眼的发病因素和治疗方法，以及一些常见的手术方法。方法：对194眼心脏死亡供体捐献(donation after cardiac death, DCD)角膜移植患者的临床资料进行回顾性分析，探讨发生继发性青光眼患者其术前原发角膜病变的类型及术后主要临床表现，同时对给予药物或手术干预后的治疗效果进行观察。结果：194眼中发生继发性青光眼者36眼，总发生率为18.56%；发生率较高的有粘连性角膜白斑、感染性角膜炎角膜溃疡、排斥再移植、大泡性角膜病变、外伤，而单纯性角膜白斑、圆锥角膜、角膜变性或营养不良的发生率相对较低。术后引起继发性青光眼发生的相关因素早期主要由于粘弹剂滞留，眼前节的严重炎症反应，术后发生虹膜粘连、房角粘连；晚期主要原因为术后使用糖皮质激素未进行规律随访，排斥反应的发生、角膜内皮失代偿等。所有患者经分析病因后给予药物或联合手术治疗眼压均得到有效控制。结论：角膜移植术后继发性青光眼的发生率与术前角膜病变的类型及原发病有相关性，根据继发性青光眼的不同病因进行相应治疗，效果满意。

Abstract: Objective: To investigate the incidence, and treatment of secondary glaucoma after keratoplasty (KP), and some common surgical methods. Methods: A retrospective analysis was made on the clinical data of 194 eyes of patients with corneal transplantation donated by donation after cardiac death (DCD) to investigate the types of primary corneal lesions before operation and the main clinical manifestations of secondary glaucoma patients. At the same time, the effect was observed under the different treatments. Results: For 194 eyes, secondary glaucoma occurred in 36 eyes, and the total incidence rate was18.56%. Higher incidence was found in eyes with adherent corneal leucoma, corneal ulcers, rejection of retrains plant, bullous keratopathy, penetrating injury, chemical injury; while the incidence of simple corneal white spot, keratoconus, corneal degenera-tion or malnutrition is relatively low. The related factors of secondary glaucoma after operation were mainly caused by the retention of viscoelastic agent, the severe inflammation of anterior segment and postoperative adhesions around the iris in the early stage, and the main cause of late stage was corneal endothelium decompensation. The use of glucocorticoid was not followed up regularly after operation, and immune rejection occurred. All patients were treated with drugs or combined surgery after analysis of the causes, and intraocular pressure was effectively controlled. Conclusion: The incidence of secondary glaucoma after keratoplasty was correlated with the types and primary diseases of corneal lesions before operation. According to the different causes of secondary glaucoma treatment, the effect is satisfactory.

文章引用：田二苗, 李兰, 李云川, 曹倩, 邹莹, 徐晓莉, 李勇. DCD角膜移植术后继发性青光眼的临床观察[J]. 眼科学, 2018, 7(4): 166-171. https://doi.org/10.12677/HJO.2018.74026

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