| Objective:Comparative study of clinical efficacy of lamellar keratoplasty with biological cornea patients with infectious corneal ulcers in different focus sites.Method:Retrospective analysis was performed on 45 consecutive cases of infectious corneal blindness in our hospital from July 2016 to December 2020,all of whom underwent biological corneal lamellar transplantation.The 45 patients were divided into central proximal pupil group and peripheral proximal limbus group according to different lesion sites.The mean best corrected visual acuity(BCVA)(Log MAR),postoperative complications,graft transparency,corneal neovascularization,graft survival,and graft success rate were observed in the two groups.The follow-up time was 1 year.SPSS17.0software was used for statistical analysis.The two groups were compared by t test,chi-square test and non-parametric rank sum test.The difference was statistically significant at P < 0.05.The Kaplan-Meier curve was used to analyze the survival rate of corneal grafts.Results:Of the 45 patients with infective corneal ulcer,24 cases were located in the central proximal pupil region and 21 cases were located in the peripheral proximal limbus.1.The average BCVA at seven days,one month,three months,six months and twelve months after operation:the central groups were 2.52±0.78,1.63±0.83,1.53±0.78,1.19±0.75 and 0.61±0.21.The peripheral groups were 1.70±0.80,1.19±0.71,0.99±0.64,0.79±0.61 and 0.76±0.57.One month after operation,the visual acuity was all improved meaningfully(P<0.05),and the BCVA at each period was increasing than previous point time(P < 0.05).Over time,the two groups of visual acuity gradually stabilized and synchronized.2.Postoperative complications: delayed epithelial healing,graft rejection,graft dissolution and infecting again all happened,and they did not have sense(P>0.05),the disease can be controlled by conservative treatment.In some cases,the disease can be controlled by conservative treatment,and even the grafts became transparent.Patients with poor control were treated with penetrating keratoplasty again.3.Graft transparency: with time increasing,the grafts in both groups gradually became transparent when there were no serious complications.4.Graft neovascularization: the proportion of graft neovascularization in the central group was higher at 3 months after surgery,while that in the peripheral group began to increase at 1 month after surgery.Twelve months after operation,the graft failure cases were excluded in both groups,the neovascularization of the remaining grafts gradually stabilized.5.Graft survival and success rate of corneal transplantation: At the last follow-up,seventeen patients in the central group were successfully transplanted,with a success rate of 71%,and seven patients failed.In the peripheral group,seventeen patients were successfully transplanted,with a success rate of 81%,and four patients failed.Compared with each other,there was no significant difference(P >0.05).Conclusions:1.For infectious keratitis at different focal sites,the biological cornea can successfully replace the human cornea for lamellar transplantation.Without serious complications,the graft gradually restored transparency,and the visual acuity was improved significantly.2.The BCVA of the two groups increased significantly after operation,and the visual acuity gradually stabilized with the prolongation of time.3.Compared with each other,two groups did not have obvious difference in terms of complications.Although rejection,dissolution,infection recurrence and other postoperative complications could occur,the condition could be controlled or even restored to transparency after treatment.Although the graft does not survive,it gives time for subsequent penetrating keratoplasty.4.There was no significant difference in the success rate of corneal transplantation and graft survival among patients with different focal sites. |
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