Abstract:

Objective To observe the effect and prognosis of keratoplasty for the treatment ofkeratoconus. Methods Twenty-four cases（24 eyes）of keratoconus with keratoplasty from April 2016 to June 2017 were studied. Of all the patients，ten cases had received penetrating keratoplasty，two cases had received lamellar keratoplasty and 10 cases had received deep lamellar keratoplasty. The refractive state of the cornea，cornealgraft，the number of corneal endothelium and the incidence of complications were observed at 1 months，3 months，6 months and 1 years after the operation. Results Postoperative corrected visual acuity was significantly improved in all patients. 12 cases（12 eyes）raised 4 ～ 5 lines，6 cases（6 eyes）raised 6 ～ 8 lines，and 6 cases（6 eyes）raised above 9 lines. Rejection action was found in 1 eye after penetrating keratoplasty. Corneal grafts were transparentin other cases，and there was no postoperative complications such as corneal opacity and double anterior chamberafter operation. The number of corneal endothelial cells decreased to varying degrees after surgery，the maximum loss rate was 3 months，and then tended to be stable. Conclusion Keratoplasty is an effective method for the treatment of advanced keratoconus. Deep lamellar keratoplasty has a lower incidence of rejection reaction and no damage foranterior chamber. It provides a safe and effective choice for the treatment of keratoconus.

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摘要：

目的 探讨角膜移植术治疗圆锥角膜的效果及预后。方法 选取 2016 年 4 月—2017 年 6 月在本院施行角膜移植的圆锥角膜患者 24 例（24 眼）为研究对象，其中行穿透性角膜移植术 10 例，板层角膜移植术 2 例，深板层角膜移植术 10 例。对其术后 1 个月、3 个月、6 个月、1 年屈光状态、角膜植片情况、角膜内皮细胞数目、并发症等进行观察。结果 所有患者术后矫正视力较术前均有提高，术后矫正视力提高 4 ～ 5 行者 12 例（12 眼），提高 6 ～ 8 行者 6 例（6 眼），提高 9 行以上者 6 例（6 眼），一例行穿透性角膜移植术患者术后发生角膜植片混浊，余 23 例患者角膜植片均透明，未发生角膜混浊等排斥反应及术后双前房等并发症。术后角膜内皮细胞数目均有不同程度下降，3 个月丢失率最大，之后趋于稳定。结论 角膜移植术是治疗晚期圆锥角膜的有效方法，深板层角膜移植术治疗圆锥角膜排斥反应发生率低、未改变眼内环境、并发症较少、手术操作相对更安全。但对于角膜瘢痕明显和急性穿孔的圆锥角膜患者，穿透性角膜移植术仍不可替代。

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