角膜移植之臨床經驗

Clinical Experiences in Keratoplasty

陳德照(Te-Tsaw Chen) ； 馬俐(Lih Ma) ； 陳媚音(May Yum Chan)

《中華民國眼科醫學會會刊》 19卷 (1980/05) Pp. 31-37

https://doi.org/10.30048/ACTASOS.198005.0005

摘要

角膜移植目前己是眼科方面很普遍而成功率很高的手術，臺灣在這方面的手術做得也相當成功。此篇報告，是本院在13個月中，替20位失明的患者，做角膜移植的情況，其中的特點為：此20位病例皆是在手術顯微鏡下，利用最精細的針線，器械，以直接縫合的方法完成，手術成功率85%，有25%患者發生排斥反應。

並列摘要

Here we report 20 cases of keratoplasty (from Oct. 1978 to Nov. 1979) including 18 cases of penetrating keratoplasty and 2 cases of lamellar keratoplasty. The patients varied in ages from 12 to 54 years with an average age of 27. There were 13 men and 7 women. The postoperative follow-up duration was from 10 days to 14 months with an average of 8 months.
The causes of the corneal opacity were: keratoconus 2, corneal dystrophy 2, traumatic opacity 3, herpes simplex keratitis 2, herpes zoster keratitis 1. bacterial ulcer 5, chemical burn 1, measles 3 and one case was suspected to be due to small pox.
The results were evaluated on the basis of visual improvement. In a total of 20 eyes, 17 (85%) were improved, 2 (10%) were stationary and 1 (5%) was worse. The cause of worsening in 1 case was postoperative phacoanaphylatic reaction (case 7). Those 2 cases that remained unchanged were due to donor failure (case 4) and postoperative hemorrhage between the interstitial layers of lamellar keratoplasty (case 14).
Early postoperative complications included shallow A-C in (15%), iris incarceration in 2 (10%), hyphema in 1 (5%), donor failure in 1 (5%) and phacoanaphylatic reaction in 1 (5%), donor failure in 1 (5%) and phacoanaphylatic reaction in 1 (5%). Late postoperative complications were graft rejection in 5 (25%), cornea! ulcer (post suture removal) in 1 (5%) and wound dehiscence (post suture removal) in 1 (5%).
In the discussion, we mentioned several points of importance attempting to gain a successful transplantation. Firstly, improvement in surgical techniques, suture materials and better selection of donor tissue can decrease the frequency of early graft failure. Secondly, early detection of the graft rejection and early treatment of the patient can prevent the disastrous opacity of the cornea after rejection. Lastly, modification of the vascularized cornea by corticosteroids or HLA-matching can improve the prognosis of keratoplasty.

並列關鍵字

Rejection operating microscope ； HLA-matching