关键词: 角膜, 感染, 移植, 复发

Abstract:

Objective To investigate the recurrence characteristics, treatment and outcome of pyogenic corneal ulcer after keratoplasty. Design Retrospective case series. Participants 292 cases of corneal transplantation (292 eyes) patients with pyogenic corneal ulcer from January 2012 to December 2016 in Beijing Puren Hospital. Penetrating keratoplasty(PK) was performed in 204 cases (204 eyes) and lamellar keratoplasty (LK) in 88 cases (88 eyes).   Methods In the 292 patients, 15 cases were postoperative recurrence in  the early stage (3 months) . The clinical characteristics, recurrence rate, recurrence time, treatment and prognosis were analyzed, and the risk factor, relapse characteristics, and the relationship between features and treatment were summarized. Main Outcome Measures Clinical features, recurrence rate, recurrence time, manifestation and treatment. Results The total recurrence rate after corneal transplantation was 5.1% (15/292 eyes). The recurrence rate after PK was 3.9% (10/204 eyes), and the recurrence rate after LK was 5.7% (5/88 reyes). The recurrence time is 4~90 days, 4~15 days early (12 cases), average (9.3±4.2) days, 16~90 days late (3 cases), average (47.0±30.6) days. Location of recurrent: 8 cases of implantation, 2 cases between implantation and corneal bed, 3 cases at implantation and with the anterior chamber abscess, 3 cases at implantation, anterior chamber abscess and vitreous opacity. In the 8 cases who relapsed at implantation and graft infection, 5 cases were performed PK surgery, and the remaining 3 cases were evisceration of eye. Two patients with abscess between implantation and corneal bed after LK were treated with iodization, one with infection control, the other with recurrence and infection control after PK. PK was performed in 2 eyes with implantation bed infiltration, anterior chamber abscess, and mild vitreous opacity, and the infections recurred after surgery, and finally the extirpation of the eye contents was performed. Among the 3 eyes who relapsed at the implantation bed with implantation infiltration and anterior chamber abscess, one eye had a recurrence of infection after anterior chamber flushing and mechanical membrane resection, and finally underwent extirpation of the eye contents. PK was done on one eye, and the infection was controlled after surgery. One eye had recurrent infection after deep anterior lamellar keratoplasty (DALK), and extirpation of the eye contents was performed. Finally, 7 eyes were saved (46.7%). The seven patients with eye ball reservation were followed up for 3 to 12 months, whose correction vision <0.02 in 3 eyes, 0.02~0.1 in 2 eyes, 0.2~0.5 in 1 eye, >0.5 in 1 eye. Conclusion The treatment of recurrent pyogenic corneal ulcer after keratoplasty is based on the location and degree of lesions, and visual function outcome in most patients is poor.

Key words: corneal, infection, transplation, reccurence