Clinical Effect Analysis Of Lamellar Keratoplasty For Keratopathy

Objective:To evaluate the clinical efficacy of lamellar keratoplasty.The etiology,the relationship between preoperative ocular conditions and complications,postoperative visual acuity,corneal graft transparency,postoperative complications and treatment of patients undergoing lamellar keratoplasty were analyzed.To investigate the feasibility of corneal stromal lenticule and acellular porcine corneal stromal as corneal transplant materials for lamellar keratoplasty in the treatment of keratopathy.To study the exact curative effect,long-term effect and safety.Methods:50 patients(50 eyes)who were admitted to the Department of Ophthalmology of the First Hospital of Jilin University from July 2014 to October 2020 for lamellar keratoplasty and were followed up regularly after surgery were selected.The therapeutic effect was analyzed retrospectively.All patients’ lesions did not involve the entire thickness of the cornea.50 eyes were diagnosed with various corneal diseases,including 29 eyes of infectious corneal ulcers(including 12 eyes of fungal corneal ulcer,11 eyes of bacterial corneal ulcer,5 eyes of viral keratitis,and 1 eye of mixed fungal and viral infection),4 eyes of Mooren’s ulcer,6 eyes of marginal degeneration,1 eye of corneal ectasia,6 eyes of limbal dermoids,2 eyes of pseudo-pterygium,1 eye of recurrent pterygium and 1 eye of corneal thermal burn.50 patients were classified in terms of the primary disease before surgery and different materials(fresh corneal tissue,glycerin-cryopreserved corneal tissue,corneal stromal lenticule,acellular porcine corneal stromal)were selected for lamellar keratoplasty or lamellar keratoplasty combined with amniotic membrane transplantation according to their conditions.29 cases underwent lamellar keratoplasty and 21 cases underwent lamellar keratoplasty combined with amniotic membrane transplantation.We followed up patients for a long time after surgery.Slit lamp examination,anterior segment photography,anterior segment optical coherence tomography and other auxiliary ophthalmic examinations were used to observe the postoperative vision and transparency of the graft.Record the occurrence and prognosis of graft rejection,corneal neovascularization,corneal graft melting,corneal graft infection,early corneal suture loosening and other complications.Analyze the impact of factors on vision improvement,implant transparency and occurrence of complications,such as gender,age,side of the affected eye,preoperative diagnosis,implant diameter and implant position.SPSS 26.0 statistical software was used for data processing.Results:After lamellar keratoplasty,the normal anatomical structure of the anterior segment of the eye of all patients recovered and the ocular surface was reconstructed.The appearance improved and some useful vision was preserved.1.There were 50 patients in this group who underwent lamellar keratoplasty due to various corneal diseases(50 eyes,including 35 males and 15 females).The youngest was 5 years old and the oldest was 82 years old.The average age was 48.44±19.976.Most patients are between 50-70 years old.In the eyes of these cases,infectious corneal ulcers caused by various reasons were the most common disease before lamellar keratoplasty(29 eyes,including 12 eyes of fungal corneal ulcer,11 eyes of bacterial corneal ulcer,5 eyes of viral keratitis,and 1 eye of mixed fungal and viral infection).2.In this study,visual acuity improved in 34 cases(68.00%)and remained unchanged in 16 cases(32.00%)after lamellar keratoplasty.16 eyes were blind before the operation,and 10 eyes recovered after the operation.The regaining rate was 62.5%.The difference between preoperative and postoperative visual acuity was statistically significant(P=0.000).3.In this group of patients,35 eyes were transparent and 15 eyes were translucent 3months after surgery.The total transparency rate was 100%.Of the 15 eyes with postoperative complications,7 eyes had transparent grafts(46.67%).Among 35 eyes without complications,28 eyes had transparent grafts(80.00%).The difference was statistically significant(P=0.040).The occurrence of complications is a factor affecting the transparency of the implant.4.In this group of patients,immune rejection occurred in 3 eyes after surgery and the rejection rate was 6.00%.It can be effectively controlled after the application of systemic and local hormones and topical immunosuppressant.5.In this group of cases,corneal neovascularization occurred in 10 cases.Corneal graft melting occurred in 2 cases.Corneal graft infection occurred in 4 cases.Early corneal suture loosening occurred in 5 cases.Shallow anterior chamber occurred in 2cases after surgery.Hemophysis between corneal graft and implant bed occurred in 1case.The condition was controlled by corresponding symptomatic treatment.Conclusion:1.Lamellar keratoplasty is a safe and effective surgical method for the treatment of corneal lesions that do not involve the entire thickness of the cornea,such as infectious corneal ulcers,Mooren’s ulcer,marginal degeneration,limbal dermoids,pseudopterygium,recurrent pterygium and corneal thermal burn.2.Corneal stromal lenticule and acellular porcine corneal stromal,as emerging donor materials,are used in lamellar keratoplasty,which can control the progression of keratopathy effectively and alleviate the shortage of corneal donors.Acellular porcine corneal stroma is safe and effective for the treatment of infective corneal ulcers that do not invade the whole cornea.3.Close observation and timely detection and early treatment after surgery can reduce the serious consequences caused by complications and increase the success rate of keratoplasty.