目的:評價皮質激素聯合環孢素對比皮質激素單用防治穿透性角膜移植(PKP)術后排斥反應的療效。方法:計算機檢索PubMed,EMBASE.com,SCI,Cochrane圖書館,CBM,CNKI數據庫,納入皮質激素聯用環孢素對比皮質激素單用防治PKP術后排斥反應的隨機對照試驗,進行方法學質量評價并應用RevMan軟件進行meta分析。結果:共納入5篇報道,1篇A級文獻,B、C級各2篇。Meta結果:術后排斥反應發生情況組間差異有統計學意義(RR=0.3,95%CI 0.140.65);對既發排斥反應的逆轉,組間差異無統計學意義(RR=1.15,95%CI 0.93-1.42)。結論:基于當前證據,皮質激素聯合環孢素防治PKP術后排斥反應療效并不優于皮質激素單用。
Objective To evaluate the effects of surgical treatment for severe ocular rupture with blood staining of cornea and non-light perception , and analyze the relative factors. Methods Seven severely rup tured eyes of 7 patients with blood staining of cornea and non-light perception underwent second-stage penetrating keratoplasty combined with vitrectomy using temporary keratoprosthesis. All injured eyes had blood staining of cornea, hemorrhage in anterior chamber and vitreous, and choroidal and retinal detachment before the second-stage surgery. The average interval of the two surgical stages was 18 days (12-21 days). The preoperative visual acuity was non-light percept ion in all injured eyes with the mean intraocular pressure of 3 mm Hg (1 mm Hg =0.133 kPa) (2-5 mm Hg).The mean follow-up period was 12 months (6-30 months). Results The postoperative visual acuity was better than light perception in 5 eyes with the best corrected visual acuity of light perception to 0.06. The retina was attached in 5 eyes (5/7). The mean postoperative intraocular pressure was 12 mm Hg(5-15 mm Hg)which was significantly higher than the preoperative one (Plt;0.05). Postoperative complications mainly included temporary intraocular hypertension (1 eye), corneal neovasculariza tion (4 eyes), cornea rejection (4 eyes), and ocular atrophy (2 eyes). Conclusion Penetrating keratoplasty combined with vitrectomy using temporary keratoprosthesis is a safe and effective method in treating severe ocular rupture with blood staining of cornea and non-light perception. (Chin J Ocul Fundus Dis，2004，20：212-214)