两种手术方式治疗真菌性角膜炎的临床观察

目的 观察深板层角膜移植术（deep lamellar keratoplasty,DLKP）和穿透性角膜移植术（penetrating keratoplasty,PKP）治疗真菌性角膜炎的临床疗效.方法 回顾44例（44眼）临床确诊为真菌性角膜炎的患者,根据共焦激光显微镜检查是否累及角膜内皮分别行DLKP 28例（28眼）或PKP 16例（16眼）.术后随访6～24个月,观察术后真菌复发情况以及拆线后两周视力和角膜地形图散光.结果 术后角膜病理切片检查均检出真菌.术后DLKP组有1例、PKP组有3例出现排斥反应,经抗排斥治疗后均好转.拆线后两周最佳矫正视力DLKP组为0.59×0.04,PKP组为0.41 ×0.05,两组间相比较差异具有统计学意义（t =2.577,P =0.01）;角膜地形图散光DLKP组为（2.0 ×0.17） D;PKP组为（2.9×0.30）D,两组间相比较差异具有统计学意义（t =0.088,P=0.016）.结论 激光共焦显微镜检查对于手术方式的选择提供了良好的客观依据.两种手术方式治疗真菌性角膜炎均有良好的疗效,DLKP术后视觉疗效优于PKP.

Clinical observation of two different operations in treatment of fungal keratitis

Objective To evaluate the efficacy and safety of deep lamellar keratoplasty （DLKP） and penetrating keratoplasty （PKP） in the treatment of fungal keratitis.Methods Forty-four patients （44 eyes） were diagnosed as fungal keratitis and no obvious effect with drug treatment.DLKP （28 cases,28 eyes） or PKP （16 cases,16 eyes） was performed according to whether involved corneal endothelium by confocal laser microscopy.Patients were followed up for 6 to 24 months to observe recurrence postoperation,visual acuity and corneal topography astigmatism two weeks after suture removal.Results Corneal histologiacal examinations of all cases were detected of fungus.One eye by DLKP and three eyes by PKP appeared graft edema and improved after anti-rejection therapy.The best corrected visual acuity （BCVA） of DLKP group was 0.59 ±0.04,and BCVA of PKP group was 0.41 ±0.05,there was significant statistically difference （t =2.577,P =0.01）.The corneal topographic astigmatism of DLKP group was （2.0 ± 0.17） D,and that of PKP group was （2.9 ± 0.30） D,there was statistically difference （t =0.088,P =0.016）.Conclusions Laser confocal microscopy is helpful in the diagnosis of fungal keratitis and in judging the depth of the filament infiltration,providing a favourable objective evidence for choice of surgical methods.Both methods have good effects in treatment of fungal keratitis.The visual functional of DLKP is outshine than that of PKP.