小切口非超声乳化囊袋内手法劈核术在硬核性白内障中的应用

目的探讨囊袋内手法劈核术在硬核性白内障手术中的临床效果。方法采用小切口非超声乳化囊袋内的手法劈核术,治疗硬核性白内障117例(159眼),分别于术后1周、1个月、3个月、6个月观察患者术后视力、散光、角膜内皮细胞丢失率、并发症等情况。结果术后1周最佳矫正视力≥0.5者占54.1%,术后散光度数为(2.00±0.75)D,角膜内皮细胞密度为(3327±231)mm-2,角膜内皮细胞丢失率为3.00%;术后1个月最佳矫正视力≥0.5者占86.2%,术后散光度数为(1.50±0.75)D,角膜内皮细胞密度为(3271±253)mm-2,角膜内皮细胞丢失率为4.64%;术后3个月最佳矫正视力≥0.5者占91.2%,术后散光度数为(1.25±0.50)D,角膜内皮细胞密度为(3267±239)mm-2,角膜内皮细胞丢失率为4.75%;术后6个月最佳矫正视力≥0.5者占92.5%,术后散光度数为(1.00±0.50)D,角膜内皮细胞密度为(3257±242)mm-2,角膜内皮细胞丢失率为5.04%,无严重并发症发生。术后视力,散光度差异均有统计学意义(均为P<0.05),角膜内皮细胞丢失率差异均无统计学意义(均为P>0.05)。结论对Ⅳ-Ⅴ级硬核性白内障应用囊袋内手法劈核术,不仅具有小切口的优点,而且角膜相关并发症少,操作更安全,术后视力恢复快。     

穿透性角膜移植术后低密度角膜内皮细胞白内障手术的临床观察

目的探讨穿透性角膜移植术(PKP)后角膜植片低内皮细胞密度的白内障患者行白内障摘除联合人工晶状体植入术的安全性。方法 PKP术后角膜内皮细胞计数<1500个/mm2行白内障摘除联合人工晶状体植入术治疗的患者15例(15只眼),根据晶状体核硬度分别选择不同的手术方式,行相应的围手术期处理,分别记录术前及术后3个月患者裸眼视力、角膜内皮细胞计数及裂隙灯观察角膜植片情况。结果术前内皮细胞计数为(1195±315)个/mm2,术后3个月内皮细胞计数为(1044±301)个/mm2,差异有统计学意义(P=0),内皮损失率为12.6%。术前及术后3个月的裸眼视力分别为0.06±0.09和0.35±0.22,两者差异有统计学意义,平均提高>5行标准视力表。白内障术后6个月之内无一例角膜内皮功能失代偿及角膜植片免疫排斥反应,角膜植片均保持透明。结论 PKP术后角膜植片内皮细胞计数<1500个/mm2的患者,只要注意围手术期治疗,选择合适的手术方法,和注意术中保护角膜内皮细胞,白内障摘除联合人工晶状体植入术是安全有效的。     

深板层角膜移植术与穿透性角膜移植术治疗真菌性角膜溃疡的效果比较

目的 比较深板层角膜移植术(DLKP)和穿透性角膜移植术(PKP)两种术式治疗真菌性角膜溃疡的效果.方法 回顾性系列病例研究.2004至2006年在宁波鄞州人民医院眼科中心临床诊断明确的真菌性角膜溃疡患者17例(17眼),其中8例行DLKP,平均年龄38.6岁,9例行PKP,平均年龄51.0岁.术后随访时间12～24个月,记录两组患者的最佳矫正视力、角膜屈光状态、角膜内皮计数及并发症.计数资料采用x2检验,计量资料采用独立样本t检验进行分析.结果 两组患者术后的视力均较术前提高,最好的最佳矫正视力达1.0,两组差异无统计学意义.DLKP组术后散光小于PKP组,差异有统计学意义(x2=12.07,P<0.05),两组散光度均低于5.00 D.术后6个月、12个月角膜内皮细胞计数DLKP组较PKP组高,差异有统计学意义(t=3.899、7.618,P<0.05).深板层角膜移植患者排斥反应的发生率较穿透性角膜移植患者低(x2=132.26,P<0.01).结论 真菌性角膜溃疡患者DLKP术后最佳矫正视力略优于PKP,角膜散光度比PKP低,并发症也较少.DLKP能减少排斥反应的发生,降低手术的失败率,是治疗真菌性角膜溃疡的一种安全有效的方法.     

ICL或TICL植入术矫治超高度近视的应用研究

目的观察有晶状体眼后房型人工晶状体ICL或TICL植入治疗超高度近视的有效性、稳定性及安全性。方法回顾性病例研究。观察我院手术治疗的超高度近视患者127例(186眼),均在球周麻醉下经3mm颞侧透明角膜切口植入ICL或TICL,术前及术后1d、1周、1个月、3个月、6个月、12个月、18个月、24个月进行随访,随访内容包括裸眼远近视力、最佳矫正视力、裂隙灯显微镜检查、TICL轴向、等效球镜值、眼压、角膜内皮细胞分析等。结果术后97.85%患者裸眼视力等于或高于术前最佳矫正视力。术后球镜度数均在-1.00~0.25D,柱镜度数均在-1.00~0D。术后眼压较术前无明显提高。术后12个月、24个月角膜内皮细胞(2615.6±144.92)mm-2、(2603.40±146.30)mm-2均较术前差异无统计学意义。术后主要并发症为夜晚眩光和光晕、高眼压、TICL轴向偏差和继发性白内障等。结论植入ICL或TICL矫治超高度近视具有有效性、安全性及稳定性。     

三种感染性角膜溃疡穿透性角膜移植术后免疫排斥反应的比较

目的　比较不同病原菌感染性角膜溃疡行穿透性角膜移植术 (PKP)后免疫排斥反应发生的情况。方法　 3组 ( 2 87例 )不同致病微生物感染的角膜溃疡行PKP术后随访 8～ 48个月 ,观察比较其免疫排斥发生率及首次排斥反应发生时间。结果　真菌性角膜溃疡术后排斥反应发生率高于细菌感染和单纯疱疹性角膜炎 (HSK)组 (P <0 0 5 ) ,细菌感染和HSK组间无显著性差异 ,真菌性角膜溃疡术后首次排斥反应发生时间集中于术后 3个月 ,较其它 2组提前。结论　持续严重的炎症反应 ,植片较大及术后早期应用免疫抑制剂受限是真菌性角膜溃疡PKP术后排斥反应发生率较高和反应时间较早的原因。建议对真菌性角膜溃疡PKP术后应仔细观察 ,发现已无真菌复发的危险时 ,要抓住时机及早抗排斥治疗。     

瞳孔成形联合虹膜夹人工晶状体植入术治疗外伤性无晶状体眼疗效观察

目的 观察瞳孔成形联合虹膜夹人工晶状体植入术治疗外伤性无晶状体眼的疗效.方法 回顾性分析在我院采用瞳孔成形联合虹膜夹人工晶状体植入术治疗的外伤后无晶状体眼患者17例17眼的临床资料.观察术后视力、角膜内皮细胞计数、眼压、人工晶状体位置、瞳孔情况及术后并发症.结果 17例患者均顺利修补损伤虹膜,瞳孔成形后成功植入虹膜夹人工晶状体,未发生严重手术并发症,人工晶状体位置稳定.术后6个月裸眼视力(0.52 +0.17),较术前视力(0.04±0.02)及术前最佳矫正视力(0.44±0.13)提高.术后6个月角膜内皮细胞计数为(1993.88±127.24)个·mm-1,较术前(2178.88±132.61)个·mm-2减少(P＜0.05),但术后未发现角膜失代偿.术前眼压(15.91 ±2.73)mmHg(1 kPa=7.5 mmHg)与术后眼压(16.69±2.61) mmHg无明显差异(P＞0.05).术后瞳孔大小(4.4±0.2)mm较术前(5.5 +0.3)mm缩小(P＜0.05),患者术后无明显畏光、眩光、复视等不适症状.结论 瞳孔成形联合虹膜夹人工晶状体植入术是治疗外伤虹膜损伤并无有效晶状体囊膜支持的无晶状体眼的安全有效方法.     

穿透性角膜移植术后白内障小切口摘除术的临床观察

目的探讨穿透性角膜移植术(PKP)后白内障行巩膜隧道小切口的疗效。方法对17例(17眼)穿透性角膜移植术后白内障患者行巩膜隧道切口,行白内障现代囊外摘除联合人工晶体植入术(ECCE IOL)观察手术前、后视力,角膜水肿情况及内皮细胞记数。术后随访3～10个月。结果术后3个月最佳矫正视力:大于0.5者10例(10/17),0.3～0.5有5例(5/17),0.1～0.3有2例,(2/17)。平均角膜内皮细胞记数1837±326个/mm,术后3个月为1750±432个/mm,差异无显著意义。平均内皮细胞损失率为6.2%。术中均无并发症出现,17眼术后角膜移植片均保持透明,术后1眼一个月后出现排斥反应,经抗排斥治疗后,移植片恢复透明。结论对穿透性角膜移植术后白内障患者,根据移植片情况,注意术中操作,巩膜隧道小切口ECCE IOL术是安全、有效的治疗方法。     

微脉冲技术和文丘里泵超声乳化白内障吸出术对角膜内皮的影响

目的 比较使用微脉冲技术和文丘里泵2种不同原理的仪器进行白内障超声乳化手术对角膜内皮细胞的影响.方法 老年性白内障47例63眼,分成使用文丘里泵组25例33眼,微脉冲超声组22例30眼,术中吸出白内障后植入Acrosoft折叠型人工晶状体,术前和术后1个月用非接触型角膜内皮显微镜测量角膜内皮细胞密度.分别计算2组角膜内皮细胞丢失率.结果 文丘里泵组术前角膜内皮细胞密度为(2 568.4±421.5)mm-2,术后角膜内皮细胞密度为(2 179.4±548.2)mm-2,术后角膜内皮细胞丢失率为15.1%,差异有统计学意义(P＜0.01).微脉冲超声组术前角膜内皮细胞密度为(2 484.6±494.5)mm-2,术后角膜内皮细胞密度为(2 232.0±505.8)mm-2,术后的角膜内皮细胞丢失率为10.2%,差异有统计学意义(P＜0.05).2组间术后内皮细胞丢失率经统计学检验有差异(P＜0.05).术后第1天,视力为0.3～1.5文丘里泵组裸眼视力大于0.5者占82.3%,视力为0.1～1.0的微脉冲超声组占79.4%.结论 微脉冲超声组术后角膜内皮细胞丢失率低于文丘里泵组,显示微脉冲技术对角膜内皮细胞的损害更小.     

青光眼术后低角膜内皮细胞密度白内障手术26例临床分析

目的观察抗青光眼小梁切除术后低角膜内皮细胞密度白内障患者行巩膜隧道小切口摘出联合肝素修饰人工晶状体植入术的疗效及并发症。方法选取我院抗青光眼小梁切除术后低角膜内皮细胞密度白内障患者22例(26眼),行巩膜隧道小切口白内障摘出联合肝素修饰人工晶状体植入术,对比观察术前与术后视力、眼压、角膜内皮细胞密度及术后并发症。结果术前与术后3个月矫正视力比较,除1眼患者术后因视神经萎缩明显、视力无明显改善外,余25眼患者术后视力较术前均有不同程度的提高;术前角膜内皮细胞密度(946～520mm-2)与术后3个月(920～499mm-2)比较,差异无统计学意义(P>0.05)。术后3d有2眼出现一过性高眼压,1周后恢复;术后1个月黄斑囊样水肿1眼,2个月后消失;术后3个月视力下降1眼,为视神经萎缩引起。术后随访期间未见角膜内皮失代偿、虹膜粘连、后囊膜破裂等严重并发症发生。结论抗青光眼小梁切除术后低角膜内皮细胞密度白内障患者行巩膜隧道小切口白内障摘出联合肝素修饰人工晶状体植入术是安全、有效的,但术前评估、手术技巧及术后处理是非常重要的。     

飞秒激光辅助的大气泡法深板层角膜移植术治疗圆锥角膜后视觉质量

目的 观察飞秒激光辅助的大气泡法深板层角膜移植术(deep anterior lamellar keratoplasty,DALK)治疗圆锥角膜的视觉质量.方法 使用自身对照观察法,纳入30例(50眼)圆锥角膜患者,均行飞秒激光下大气泡法DALK治疗,随访1 a观察疗效.结果 30例(50眼)患者均顺利完成手术,术后早期术眼角膜植片均透明,角膜生理厚度恢复,植片与植床后弹力层贴合较好;术后7d、1个月、6个月、1 a患眼裸眼视力、最佳矫正视力均高于术前(均为P＜0.05),术后不同时间点间差异均无统计学意义(均为P＞0.05).术后不同时间点角膜曲率、角膜散光均较术前显著降低,角膜最薄点厚度较术前显著增加(均为P＜0.05),术后7d、1个月、6个月、1 a间各指标差异均无统计学意义(均为P＞0.05).术前内皮细胞密度为(2989.34±294.52)个·mm.,术后1 a为(2821.19±325.51)个·mm-2,角膜内皮细胞丢失率为(5.62±0.56)％,术后7d、1个月、6个月、1 a间差异不显著(均为P＞0.05).术中未见并发症发生;术后1眼伤口哆开,1眼缝线松弛,1眼发生基质层免疫排斥反应,未见其他并发症发生.结论 圆锥角膜行飞秒激光辅助的大气泡法DALK治疗,疗效确切,安全性高,是中晚期患者较佳的术式选择.     

Functional results of contact lens correction and penetrating keratoplasty in keratoconus. Report 1. Analysis of resolution ability of the eye

Comparative analysis of functional results of contact lens correction and penetrating keratoplasty (PKP) in keratoconus are presented. To assess resolution ability we considered visual acuity and contrast sensitivity. 117 patients (219 eyes) with stage I-IV keratoconus, wearing rigid gas-permeable contact lenses (RPCL), and 60 patients (64 eyes) after PKP were examined. In 69% patients after PKP non-corrected visual acuity (NCVA) was 0.1 or more and mean best corrected visual acuity (BCVA) was 0.63, that is similar to efficacy of contact lens correction in stage III-IV keratoconus. In 31% patients NCVA after PKP was less than 0.1 due to significant refractive arrow, visual rehabilitation of these patients required use of RPCL or refractive surgery. Contrast sensitivity in medium frequencies after PKP was almost similar to that of contact lens correction in stage III keratoconus, and in high frequencies it was close to that of stage IV.     

Visual rehabilitation and outcomes for ectasia after corneal refractive surgery

PURPOSE: To analyze the visual outcomes and method of final visual correction in eyes with corneal ectasia after laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK). SETTING: Emory University Department of Ophthalmology and Emory Vision, Atlanta, Georgia, USA. METHODS: This retrospective review comprised 74 eyes of 45 patients with corneal ectasia after LASIK (72 eyes) or PRK (2 eyes). Outcomes included postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), best corrected visual acuity (BCVA), and refraction; method of final visual correction; and time to rigid gas-permeable (RGP) contact lens failure. RESULTS: Corneal ectasia developed a mean of 19.2 months after surgery. Postoperatively, the mean UCVA was 20/400 and the mean BSCVA before ectasia management was 20/108. After ectasia management, the mean BCVA was 20/37 and the final BCVA was 20/40 or better in 78% of eyes. Final visual correction was achieved with RGP lenses in 77% of eyes, spectacles in 9%, collagen crosslinking in 3%, intracorneal ring segments in 1%, and penetrating keratoplasty (PKP) in 8%. Two eyes with intracorneal ring segments required segment explantation and subsequent PKP. One eye that had PKP had a graft-rejection episode; there were no graft failures. Two eyes (3%) did not require a visual device to improve visual acuity. The mean time for successful RGP lens wear was 24.8 months; 80% of cases initially managed with RGP lenses were successful with this form of treatment. CONCLUSIONS: The majority of eyes developing postoperative corneal ectasia achieved functional visual acuity with RGP lens wear and did not require further intervention. Penetrating keratoplasty can usually be postponed or avoided by alternative methods of visual rehabilitation; however, PKP, when necessary, can provide good visual outcomes.     

Superficial lamellar keratectomy using an automated microkeratome to excise corneal scarring caused by photorefractive keratectomy.

Corneal haze is a recognized complication of excimer laser photorefractive keratectomy. When severe, it can result in the formation of a dense corneal scar, with a reduction in best corrected visual acuity. In extreme cases, medical treatment and repeated phototherapeutic excimer ablations may fail to restore corneal transparency. In these patients, penetrating keratoplasty (PKP) has been used to restore visual function. We describe a technique for excising a superficial corneal scar using an automated microkeratome. The resultant corneal surface is quite smooth, and good visual acuity may be restored without resorting to PKP.     

Penetrating keratoplasty versus intrastromal corneal ring segments to correct bilateral corneal ectasia: preliminary study

PURPOSE: To describe the outcomes over time in patients with corneal ectasia pathology treated with intrastromal corneal ring segments (Intacs, Addition Technology, Inc.) in 1 eye and penetrating keratoplasty (PKP) in the other eye. SETTING: Clinica de Cornea, Centro Medico Docente La Trinidad, Caracas, Venezuela. METHODS: A nonrandomized comparative study and analysis of retrospective data comprised 17 patients who had PKP in 1 eye and Intacs implantation in the other eye. Patients were classified into 2 groups: asymmetric (different grade of keratoconus in each eye) and symmetric (same grade of keratoconus in both eyes). Parameters analyzed included uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and keratometry (flat and steep values and astigmatism readings). Follow-up after PKP was at 24 hours and 6 and 24 months and after Intacs implantation, at 24 hours and 3 and 10 months. RESULTS: In both groups, UCVA improved and the corneal shape was normal. No patient lost a line of acuity, and BCVA improved in both groups. CONCLUSIONS: Eyes with Intacs had a shorter recovery time than eyes having PKP. The eyes with Intacs had no complications. Complications in eyes with PKP included cataract, graft rejection, and elevated intraocular pressure. Thus, Intacs segments may delay or prevent the need for a corneal graft, although longer follow-up is needed.     

板层角膜移植术治疗基质型活动期单纯疱疹性角膜炎的临床价值

客观评估板层角膜移植术 (Lamellarkeratoplasty ,LKP)治疗基质型活动期单纯疱疹性角膜炎 (herpessimplexkeratitis ,HSK)的临床价值。方法 :对 71例 ( 71只眼 )HSK基质型活动期患者分两组 ,一组 ( 33例 )行LKP ,另一组 ( 38例 )行穿透性角膜移植术 (pene tratingkeratoplasty ,PKP) ,比较两组病人术后的疗效与并发症。结果 :LKP组术后在视力、角膜移植片排斥反应发生率、原发病复发率与内眼手术并发症发生率等方面均明显优于PKP组 (P <0 0 1)。结论 :在适应症范围内 ,成功的LKP具有清除病灶彻底、排斥反应发生率低、无内眼手术并发症等优点 ,是治疗基质型活动期HSK的理想方法。     

Penetrating keratoplasty for keratoconus: a long-term review of results and complications

PURPOSE: To study the long-term complications of penetrating keratoplasty (PKP) to evaluate current recommendations to patients with keratoconus. SETTING: John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Retrospective study of all PKP procedures for keratoconus performed by 4 surgeons during a 312 year period. Follow-up was 1 day and 1, 3, 6, 12, and 24 months post-PKP. Data from 93 eyes were reviewed for allograft reaction, astigmatism, visual acuity, reasons for decreased visual acuity, and other complications. RESULTS: Allograft reaction was seen in 31% of cases but no graft failure due to allograft reaction. Mean astigmatism was 2.76 diopters (D) +/- 1.99 (SD) at 24 months, with only 15% > 5.00 D. Last best corrected visual acuity was 20/25 or better in 77% of cases (87% had 20/25 or better at some time during follow-up). Complications that did not cause decreased visual acuity were noted. Punctate keratitis was noted in 20% of patients 180 days or more after surgery. CONCLUSIONS: Penetrating keratoplasty is a good treatment option for patients with keratoconus but should be reserved for those who do not tolerate contact lenses or do not get needed visual acuity with contact lenses because of complications. This procedure has become a second-line treatment for keratoconus patients and has generally good results.     

穿透性角膜移植术与板层角膜移植术治疗圆锥角膜术后客观视觉质量比较

目的：探讨采用双通道视觉质量分析系统（OQAS）评估圆锥角膜患者行穿透性角膜移植术（PKP）和 板层角膜移植术（LKP）后的客观视觉质量。方法：前瞻性临床研究。收集2016年1月至2017年12 月在青岛眼科医院因圆锥角膜行角膜移植的患者40例进行研究,其中PKP组23例（24眼）,LKP组 17例（19眼）,术前2组患者最佳矫正视力、屈光度和临床分期差异均无统计学意义,术后随访并应 用OQAS检查术后的客观视觉质量,检查指标包括客观散射指数（OSI）、调制传递函数（MTF）截止 频率、客观对比度视力和泪膜质量OSI变化。分类变量比较采用χ2 检验,组间连续变量比较采用独 立样本t检验。结果：术后随访23～25个月,PKP组和LKP组患者角膜植片均保持透明状态,2组间 最佳矫正视力、球镜度和柱镜度差异均无统计学意义,但PKP组角膜内皮细胞计数明显低于LKP组 （t=3.91,P<0.001）。PKP组的斯特列尔比、20%对比度视力、9%对比度视力以及OSI与LKP组相比, 差异均无统计学意义。PKP组的MTF截止频率和100%对比度视力较LKP组高,差异均有统计学意 义（t=2.58,P=0.01;t=2.66,P=0.01）。泪膜质量OSI在LKP组明显高于PKP组,差异有统计学意义 （t=3.48,P<0.001）。结论：双通道OQAS测量结果表明圆锥角膜患者行PKP术后的客观视觉质量优 于行LKP术后,PKP术后的MTF截止频率和对比度视力高于LKP术后。     

Comparison of the Objective Optical Quality in Keratoconus Patients after Penetrating Keratoplasty versus Lamellar Keratoplasty

Objective: To evaluate the optical quality of keratoconus patients after penetrating keratoplasty (PKP) or lamellar keratoplasty (LKP) using a dual-channel optical quality analysis system (OQAS). Methods: This was a prospective study. A total of 40 keratoconus patients in Qingdao Eye Hospital were involved in thisstudy from January 2016 to December 2017. And they were divided into a PKP group (23 patients, 24 eyes) or LKP group (17 patients, 19 eyes), depending on the surgical selection. Visual acuity, astigmatism, the density of the corneal endothelium cells, objective scatter index (OSI), predicted visual acuity (PVA), modulation transfer function cut-off frequency (MTF cutoff), Strehl ratio (SR) and tear film analysis of the mean OSI with a dual-channel optical quality analysis system were compared. Data were analyzed using χ2 test and independent t test. Results: There was no statistically significant difference between the PKP group and the LKP group for best corrected visual acuity, and spherical and cylindrical powers. But there was a significant difference between the two groups in the density of the corneal endothelium cells (t=3.91, P<0.001). In addition, there were statistically significant differences between the PKP and the LKP groups for the MTF cutoff and PVA100 (t=2.58, P=0.01; t=2.66, P=0.01). There was also a statistically significant difference between the PKP group and the LKP group in the tear film analysis mean OSI (t=3.48, P<0.001). Conclusions: The objective optical qualities of keratoconus patients after PKP measured by OQAS are better than after LKP, and the MTF cutoff and contrast vision are also better.     

Penetrating keratoplasty in young children with congenital hereditary endothelial dystrophy

PURPOSE: To report the visual results and success rate of penetrating keratoplasty (PKP) in a series of young children with congenital hereditary endothelial dystrophy (CHED). METHODS: This is a retrospective study on twenty-four eyes of 15 patients (seven male and eight female) operated on for CHED. Children less than 12 years of age at the time of surgery who were followed for at least 6 months were recalled. Characteristics of the patients, indications for PKP, final visual outcome, and graft clarity were evaluated. The following tests were employed: McNemmar test for evaluating visual results, Kaplan-Meyer analysis for determination of graft survival, and Mann-Whitney U test for evaluating the relationship between visual outcome and age at PKP. RESULTS: Patients' age at diagnosis and at initial PKP was 6.5 +/- 3.6 and 8.1 +/- 2.5 years, respectively. Follow-up period was 35.5 +/- 36.2 months. Visual acuity could be evaluated by Snellen chart in 19 eyes. Preoperative visual acuity was less than 20/80 in all of these. Postoperatively, visual acuity was less than 20/80 in nine eyes (47.4%) (P < 0.002). Visual acuity improved in 18 (94.7%) of 19 eyes. There was no relationship between age at initial PKP and final visual outcome (P = 0.35). At the last examination (24 grafts), 19 were clear (79.1%), two were hazy (8.3%), and three were opaque (12.5%). Allograft rejection was seen in 10 eyes (43.4%), seven of which were endothelial. Excluding one case of trauma, all graft failures resulted from endothelial rejection. The probability of primary graft survival was 88% at 3 years and 74% at 5 years. CONCLUSION: Regarding the difficulties in pediatric keratoplasty and the absence of a relationship between postoperative visual outcome and age at keratoplasty, a conservative approach and careful risk-benefit ratio evaluation are recommended in patients with CHED.     

单纯疱疹性角膜炎活动期行穿透性角膜移植术的疗效评价

目的 评价复发型单纯疱疹性角膜炎（herpes simplex keratitis,HSK)基质型活动期行穿透性角移植术的治疗效果。方法 对66例（66只眼）HSK基质型活动期患者行穿透性角膜移植术（penetrating keratoplasty,PKP),并与同期59例（59只眼）HSK基质型稳定期的PKP术后患者的疗效进行对比。结果 两组HSK患者术后角膜植片透明率、原发病复发率及视力间比较差异无显著性（P＞0．05）。结论 HSK基质型活动期行PKP术,只要术前和术中处理得当,不仅可缩短病程和减少并发症,而且还能取得与HSK基质型稳定期行PKP手术同样的疗效。