中文摘要：

背景 角膜移植术后由于糖皮质激素类药物和免疫抑制剂的长期使用而导致眼组织的免疫能力下降,从而引起炎性病变,主要表现为术眼角膜内皮炎症反应,常见有病毒性角膜内皮炎和内皮型排斥反应,二者的临床症状相似,但治疗方法和预后有所不同,因此二者的鉴别诊断至关重要,但目前相关研究较少.目的 观察和比较角膜移植术后病毒性角膜内皮炎和内皮型移植排斥反应的临床特征,为临床诊断和治疗提供参考依据.方法 对2011年1月至2013年9月在北京大学眼科中心接受角膜移植术后发生内皮炎症反应的29例患者的病历资料进行回顾性分析,检查项目包括裂隙灯显微镜检查、激光扫描共焦显微镜检查、病毒血清学检测,并采用Goldmann眼压计测量眼压,根据临床症状将患者分为病毒性角膜内皮炎组17例和内皮型排斥反应组12例,分别行抗病毒药物联合糖皮质激素治疗和局部糖皮质激素联合免疫抑制剂治疗,眼压升高者局部用酒石酸溴莫尼定滴眼液和/或马来酸噻吗心安滴眼液点眼,根据二者的临床表现、检查结果和治疗结果总结2种病变的鉴别点.结果 2个组患者接受的术式均为穿透角膜移植术,组间患者术前不同角膜原发病例数的差异有统计学意义（P=0.000）;内皮型排斥反应组患者眼压为（16.00±3.19） mmHg（l mmHg=0.133 kPa）,明显低于病毒性角膜内皮炎组的（34.00±3.84） mmHg,差异有统计学意义（￡=13.298,P=0.000）;内皮型排斥反应组患者术后发病时间为（21.92±8.60）个月,明显长于病毒性角膜内皮炎组的（14.41±5.79）个月,差异有统计学意义（t=-2.816,P=0.009）;内皮型排斥反应组患者平均年龄为（44.00±16.71）岁,明显小于病毒性角膜内皮炎组的（57.24±12.66）岁,差异有统计学意义（t=2.429,P=0.022）.病毒性角膜内皮炎眼角膜后沉着物（KP）呈色素羊脂状,排列散乱,角膜严重水肿,?

英文摘要：

Background The administration of glucocorticoid drugs and immunosupressor results in reducing immune competence and therefore induces inflammatory lesions,such as corneal endotheliitis and endothelial rejection.Corneal endotheliitis and endothelial rejection have rather similar clinical manifestations,but their managements are different,therefore,their differential diagnosis is very important.Objective This study aimed to observe and compare the clinical characteristics of viral corneal endotheliitis and endothelial rejection following corneal transplantation.Methods The clinical data of 29 cases with corneal endothelial inflammatory reaction following corneal transplantation from January 2011 to September 2013 were retrospectively analyzed in Peking University Eye Center.The examinations included ocular anterior segment findings by slit lamp microscope and confocal laser scanning microscope,intraocular pressure （IOP） measurement by Goldmann tonometer and serum lgG detection.The patients were divided into corneal endotheliitis group 17 patients and endothelial rejection group 12 patients according to clinical findings.The combination of antiviral therapy with glucoeortieoid drugs or the combination of topical glucocorticoid drugs with immunosupressor was carried out on the two groups,respectively.Brimonidine tartrate eye drops or timolol eye drops was used to lower IOP.The clinical characteristics between corneal endotheliitis and endothelial rejection after corneal transplantation were compared and differentiated.Results The patients received penetrating corneal transplantation,and the number of different corneal diseases was significantdifferent between the two groups （P=0.000）.The IOP in the endothelial rejection group was （16.00±3.19）mmHg,which was significantly lower than （34.00±3.84） mmHg in the corneal endotheliitis （t =13.298,P =0.000）.The onset time after operation was （21.92 ± 8.60） months and the age was （44.00 ± 16.71） years in the endothelial rejection group,and those