病例研究

异体角膜基质透镜移植治疗角膜穿孔:2例病例报告及文献复习

Allogeneic corneal stromal lamellar keratoplasty in the treatment of corneal perforation: two case reports and literature review

:875-884
 
角膜基质透镜是带有一定屈光度的角膜组织,为利用激光或板层刀等在角膜基质层内雕刻出一个精确对焦点的光学透镜。随着角膜屈光手术的不断发展,术中产生了大量的角膜基质透镜, 越来越多的学者也将目光聚焦于此。我国角膜供体来源匮乏与手术量需求严重不匹配, 眼库严重缺乏供体角膜,而对角膜组织的需求却越来越大。角膜穿孔作为角膜疾病的终末阶段,严重威胁患者的视力,甚至要面临摘除眼球的风险, 是对患者身体与心理的双重打击。绝大多数的角膜穿孔需要紧急手术处理, 对于一些常规治疗无效或角膜病变更严重的,角膜移植术可能是唯一有效的手段。对原本废弃的透镜重新利用, 将其用于治疗角膜溃疡、修补角膜穿孔以及辅助治疗各类角膜疾病的危重阶段, 均观察到其取得了良好的效果, 这在一定程度上缓解了临床上角膜供体缺乏的现状。本文报道了2例由角膜白斑引起的角膜穿孔患者使用异体角膜基质透镜移植治疗的病例, 术后2名患者病情均得到稳定。同时探讨了角膜基质透镜移植的局限性, 本文并未观察到角膜透镜移植对于感染性、免疫性等其他原因造成的角膜穿孔的疗效, 因此在行角膜移植之前,要正确认识及处理原发病,尽量避免一些并发症和排斥反应的发生。
Corneal stromal lenses are corneal tissues with specific refractive power, created by precisely sculpting an optical lens within the corneal stromal layer using lasers or microkeratomes. With the ongoing development of corneal refractive surgery, a large amount of corneal stromal lenses are generated during procedures, drawing increasing attention from researchers. In China, there exists a severe mismatch between the scarcity of corneal donors and the high demand for surgical procedures. This has led to a critical shortage of donor corneas in eye banks, while the need for corneal tissue keeps rising. Corneal perforation, which is the end-stage of various corneal diseases, poses a significant threat to patients' vision and may even result in enucleation, causing considerable physical and psychological distress. Most cases of corneal perforation require urgent surgical intervention. For patients with severe conditions or those for whom conventional treatments are ineffective, corneal transplantation may be the only viable option. Reusing stromal lenses that were previously discarded to treat corneal ulcers, repair corneal perforations, and assist in managing critical stages of various corneal diseases has shown promising results. This, to some extent, helps alleviate the clinical shortage of donor corneas. This article presents two cases of corneal perforation caused by corneal leukoma, both of which were successfully treated with allogeneic corneal stromal lens transplantation. Both patients achieved stable conditions after the operation. Additionally, this paper discusses the limitations of corneal stromal lens transplantation. The efficacy of corneal lens transplantation for perforations caused by infectious or immunological etiologies was not observed in this study. Therefore, it is essential to accurately diagnose and manage the underlying disease before transplantation and to minimize the occurrence of complications and rejection reactions.
论著

全飞秒激光小切口角膜基质透镜取出术患者围手术期体验的质性研究

Perioperative experience in small incision lenticule extraction patients: a qualitative study

:149-153
 
目的:了解行全飞秒激光小切口角膜基质透镜取出术(small incision lenticule extraction,SMILE)患者围手术期的体验感受。方法:采用定性调查的方法,选取广东省某医院的15名行SMILE的患者,进行半结构式访谈,将患者围手术期体验归纳为顾虑、紧张、疼痛、担心、放松5个主题概念,用现象学分析法整理、分析资料。结果:把5种体验汇总制成韦恩图,通过韦恩图提炼发现有1人有围手术期5种感受,3位有紧张、疼痛、担心、放松4种心理感受,2位只有紧张的感受,而无其余感受。结论:行SMILE患者的围手术期具有多种体验感受,分析不同感受状态和因素,为眼科医护人员对于寻求SMILE手术的患者做好围手术期的服务提供依据。
Objective: To investigate the perioperative experience after small incision lenticule extraction (SMILE). Methods: A semi-structured interview was conducted in 15 patients who underwent SMILE surgery in Zhuhai People’s Hospital.The data were collected and analyzed by phenomenological analysis. Results: The perioperative feelings of patients were summarized into five categories: concern, tension, pain, worry and relaxation. These feelings were compiled and extracted by Venn diagram. One patient had all five categories of feelings during the perioperative period. Three patients experienced four psychological feelings of tension, pain, worry and relaxation, and 2 patients had only nervous feelings during the full femtosecond operation period. Conclusion: Patients undergoing SMILE have avariety of experience feelings during perioperative period. Analysis of different feeling states and factors will provide evidence for ophthalmic medical staff to provide perioperative services for patients seeking SMILE surgery.
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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