摘要
目的探讨严重且复杂的大泡性角膜病变行无缝线深板层角膜内皮移植术（DLEK）的可行性、并发症及处理措施。方法采用非随机回顾性连续病例研究。2005年10月至2006年3月在中山大学中山眼科中心对15例（15只眼）严重且复杂的大泡性角膜病变行无缝线DLEK联合前段玻璃体切除术（2例联合睫状体沟缝线固定人工晶状体植入术，2例联合人工晶状体摘出术，1例联合人工晶状体置换术）。术后4—6个月，4例无晶状体眼行睫状体沟缝线固定人工晶状体植入术。术后复查视力、角膜散光、角膜曲率及内皮细胞密度，用眼前段光学相干断层成像（OCT）检查深板层内皮植片的愈合情况。采用重复测量的方差分析检验时间点之间的差异。结果术后13例植片与植床贴附良好；1例植片移位，经重新复位后贴附良好；1例层间积液，5d后吸收。随访期内，所有植片均透明。5例（33．3％）植片与植床边缘间有约0．5—1．0mm宽的裂隙，其中2例（13．3％）在裂隙处上皮面出现小水泡，分别于术后2周和3个月后消失。术后4例（26．7％）裸眼视力为0.4，3例（20．0％）裸眼视力为0．3，4例（26．7％）裸眼视力为0．2，1例（6．7％）裸眼视力为0．1。术后6、9及12个月，角膜散光度数分别为（2．80±0．70）D、（2．60±0．70）D及（2．20±0．60）D（F=5．591，P=0．090）；角膜曲率分别为（43．60±1．90）D、（44．10±1．30）D及（44．10±1．00）D（F：1．515，P=0．237）；术前、术后6、9及12个月，角膜厚度分别为（666．1±70．6）la,m、（544．5±30．9）μm、（538．2±34．7）μm及（532．4±41．6）μm（F=32．692，P=0．000）。术后内皮细胞密度为（1915．7±90．8）个／mm^2。结论严重且复杂的大泡性角膜病变行无缝线DLEK是安全、有效的，但通常需联合其他的眼前段手术。DLEK术后4—6个月，无缝线的植片可耐受其他的眼前段手术。
Objective To investigate the efficacy, postoperative complications and management of deep lamellar endothelial keratoplasty （DLEK） in complex cases of severe bullous keratopathy. Methods In the nonrandomized retrospective consecutive case series, fifteen cases （15 eyes） of severe and complex bullous keratopathy at Zhongshan Ophthalmic Center underwent DLEK in combination with other intraocular surgeries between October 2005 and March 2006. DLEK was combined with vitrectomy and ciliary sulcus sutured intraocular lens implantation in two patients, with vitrectomy and intraocular lens extraction in two patients and with vitrectomy and intraocular lens exchange in one patient. Four patients with aphakic eyes underwent subsequent ciliary sulcus sutured intraocular lens implantation within 4 to 6 months after the DLEK donor tissue had been placed. The best spectacle corrected visual acuity （BSCVA）, corneal astigmatism, curvature and endothelial cell density （ECD） were examined preoperatively and postoperatively. The graft-host interface was photographed by anterior segment optic coherent tomography （OCT）. Repeated Measures Anova was applied for management of the data. Results On postoperative day 1, 13 grafts were well attached to the host except for one dislocation （re-located immediately and well attached）. Fluid leakage between the graft-host interface occurred in one eye （absorbed on day 5）. All the grafts remained clear during the follow-up. Five cases （33.3%） showed narrow gaps between the borders of graft and host. Bullous epithelial lesion reoccurred above the gap in two cases （ 13. 3% ）, and disappeared during follow-up. BSCVA in 4 eyes （ 26. 7% ） was 0. 4, in 3 eyes （ 20. 0% ） was 0. 3, in 4 eyes （ 26. 7% ） was0.2, and in 1 eye （6.7%） was 0.1 after DLEK. At 6,9 and 12 months, the average corneal astigmatism were （2.80±0.70） D,（2.60±0.70）D and （2.20±0.60） D （F=5.591,P=0.090）, average corneal curvature were （43. 60± 1.90） D, （44. 10 ± 1.30） D and （44. 10 ±1.00） D （ F = 1. 515, P =0. 237） . The average central corneal thickness were （ 666. 1 ± 70. 6 ） μm, （ 544. 5 ± 30. 9 ） μm, （538.2± 34.7） μm and （532.4 ± 41.6）μm （F = 32. 692, P = 0.000） at preoperatively, 6,9 and 12 months postoperatively, respectively. The mean ECD was （ 1915.7 ± 90. 8 ） cells/mm^2 postoperatively. Conclusions DLEK surgery is an effective and safe procedure in severe and complex cases of bullous keratopathy,but it has to be successfully combined with other anterior segment surgeries. DLEK graft without sutures can tolerate subsequent other anterior segment surgeries at 4 to 6 months after placement of the donor tissue.
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2008年第8期726-733,共8页
Chinese Journal of Ophthalmology
基金
广东省科技计划资助项目（2004B40501008,2005B30901016）
关键词
角膜移植
眼外科手术
角膜疾病
手术后并发症
Corneal transplantation
Ophthalmologie surgical procedures
Corneal diseases
Postoperative complications
