The Clinical Analysis Of 104 Cases Which Occurred Rejection After Penetrating Keratoplasty

Penetrating keratoplasty is a kind of corneal transplantation including corneal endothelium, we use integral and health corneal instating the sick one. Not only can we keep the integrity of the eyeball, control the developing of sickness, but also can improve the eyesight. It can be used to cure a lot of diseases, in China for example, we use it mostly to cure infectious keratitis, secondly, to all kinds of maculae corneae which can be caused by many reasons. It also can be used to the sickness of bullous keratopathy, keratoconus, corneal dystrophy and corneal degeneration. It is a very useful technique. Our hospital can use this technique to clinic from 20th century 80's. Because of the developing of the micro-surgical instruments, melioration of Suture materials, the technic of the operation, and the study of the Immune mechanisms of corneal transplant and how to prevent and deal with it are progressing, the penetrating keratoplasty is already becoming a very important operation for the patient of eyes.Although the mission success rate of this kind of operation is very high, and it can help to give away the disease and help the patients to see again, the reject reaction after the operation of the penetrating keratoplasty is a trouble for all doctors. To better understand the occurrence of corneal transplant rejection mechanism, to control perioperative and postoperative, and to reduce corneal graft rejection which is the main reason for the failure of the operation, the author collects and collates 104 cases in our hospital from January 2007 to June 2009, and analyzes penetrating keratoplasty in patients with regular postoperative follow-up clinical data, thus penetrating keratoplasty patient's age, etiology, preoperative eye condition, intraoperative management, postoperative treatment of corneal rejection in the situation analysis of the relationship. Meanwhile, China's corneal graft rejection mechanism and prevention are discussed.This group of patients to our hospital is the one who came from January 2007 to June 2009 for penetrating keratoplasty in patients with a return visit after regular. Among the 104cases, 58 cases are male, 46 cases are female. Age waves from 18 to 69, 25cases for the age of 18-30, 70 cases for the age of 31-60, 9 cases for the patients who are more than 60 years old. The average age is 39.4. 48 eyes are left, 56 cases are right eyes. 49 cases are keratoleukoma ,20 cases are fungal corneal ulcer, 6 cases are viral corneal ulcer, 7 cases are bullous keratopathy, 5 cases are corneal degeneration and corneal dystrophy, 4 cases are corneal abscess, 2 cases are bacterial keratitis, 3 cases are keratoconus, 8 cases are other diseases..Firstly, Preoperative situation1. The patients were 104 preoperative uncorrected visual acuity distribution.Light perception in 11, hand 29, the index 18 ,0.01-0.05 for the 24 ,0.05-0.1 to 13 ,0.1-0.3 7,> 0.3 to 2. Patients with eye symptoms: varying degrees of corneal vascularization 28, hypopyon in 13 eyes, 11 eyes of preoperative shallow anterior chamber, pupil adhesion 19, has been in intraocular lens implantation in 12 eyes, accompanied by old iris ciliary body inflammation 32.2. recipient ageIn the 104 patients receiving penetrating keratoplasty, and regular follow-up of patients, the youngest 18 years old, maximum 69 years, mean age 39.4 years. The majority of patients with 30-49 years of age.3. the causes of penetrating keratoplastyRecorded in this study penetrating keratoplasty is the most common and due to corneal spot, a total of 49 cases (47.1%); followed infectious keratitis, a total of 28 patients (26.9%), and fungal keratitis 20 cases, 6 cases of viral keratitis, bacterial keratitis in 2 patients. Bullous keratopathy in 7 cases (6.7%) corneal dystrophy in 5 cases (4.8%) there are other causes, such as keratoconus, corneal abscess in 15 cases (14.4%).Secondly Postoperative conditions1. Visual acuity104 patients in this group after the distribution of uncorrected visual acuity. Light perception in one, manual 4, index 3 ,0.01-0.05 for the 29 ,0.05-0.1 to 35 ,0.1-0.3 20,> 0.3 to 12. Visual acuity improved in 96 eyes, visual acuity in 5 eyes, a slight drop in visual acuity in 3 eyes.2. Immune rejectionthe patients were a total of 104 cases, 38 cases of rejection occurred. Rejection rate was 36.5%. Rejection of the long time span, the first 29 days after surgery occurred, mostly in the 3 months after, there appeared in the year after rejection. Rejection of many of the clinical manifestations, most patients is already technically successful corneal transplant surgery, in about two weeks time after sudden ciliary hemorrhage, varying degrees of corneal epithelial edema, thickening and transparency decreased corneal calm goods. Most patients have symptoms of eye pain, accompanied by epithelial or endothelial rejection line production, decreased vision. The patients in the majority of patients with 30-49 years of age, patients younger than 50 than in patients older than 50 years after rejection of the possibility of occurrence of larger, and this may be due to age, function of the immune system is relatively caused the decline.Recorded in this study penetrating keratoplasty is the most common and due to corneal spot, a total of 49 cases (47.1%); followed infectious keratitis, a total of 28 patients (26.9%), and fungal keratitis 20 cases, 6 cases of viral keratitis, bacterial keratitis in 2 patients. Bullous keratopathy in 7 cases (6.7%) corneal dystrophy in 5 cases (4.8%) there are other causes, such as keratoconus, corneal abscess in 15 cases (14.4%). Icon can be seen from the above, white is the group of cases of corneal penetrating keratoplasty Bank the main cause, followed by various types of infectious keratitis. As the cornea in which white and bullous keratopathy caused by high rates of acute rejection.Recorded in this study penetrating keratoplasty is the most common and due to corneal spot, a total of 49 cases (47.1%); followed infectious keratitis, a total of 28 patients (26.9%), and fungal keratitis 20 cases, 6 cases of viral keratitis, bacterial keratitis in 2 patients. Bullous keratopathy in 7 cases (6.7%) corneal dystrophy in 5 cases (4.8%) there are other causes, such as keratoconus, corneal abscess in 15 cases (14.4%). Icon can be seen from the above, white is the group of cases of corneal penetrating keratoplasty Bank the main cause, followed by various types of infectious keratitis. As the cornea in which white and bullous keratopathy caused by high rates of acute rejection.Graft is too large, too close to the corneal limbus, or with full corneal transplant. When more than 8.5mm diameter implant or graft over the edge near the limbus, because close to the limbal blood vessels and lymphatic network, which will increase the risk of graft rejection occurred. As a corneal limbal epithelial cell proliferation and migration of power, penetrating keratoplasty graft epithelial period of time after the operation will eventually be replaced by epithelial receptors, the limbal stem cell function is normal, affecting the operation important factors for success. If the patient is severely damaged limbal stem cells, the need for limbal limbal transplantation or with the whole cornea transplant, which would increase the risk of graft rejection. Size graft surgery is a contradiction of factors, graft should be large enough so as to enable low corneal endothelial density Buzhi Yu, otherwise it will withstand the trauma of loss, postoperative inflammation of the attack of secondary of graft endothelial failure. However, the use of larger grafts, while providing more endothelial cells, but also increases the risk of rejectionTherefore, we believe that penetrating keratoplasty corneal surgery is an important means of treatment, depending on their growth effects are very significant. Infectious keratitis and corneal caused by a variety of reasons white line in a period of time continues to be our main reason for penetrating keratoplasty, also affect the incidence of acute rejection of major preoperative risk factors for eye disease due to and the risk of eye, corneal transplant complications is also important. With the constant improvement of corneal transplantation, penetrating keratoplasty will further play an important role in their sight restoring.