摘要
目的观察角膜内皮移植手术（EK）治疗穿透性角膜移植手术（PKP）后植片失代偿的临床效果。方法回顾性病例研究。收集自2008年8月至2010年10月，在爱尔眼科医院集团因不同原因接受PKP手术，术后因免疫排斥反应导致植片内皮失代偿的患者资料5例。所有病例采取不撕除后弹力层的EK术。供体植片采取手工剥板层或用飞秒激光制作，厚度200μm左右，直径8．00～8．75mm。用植入镊或缝线牵引法，经巩膜隧道5．00mm切口植入。术后常规处理，观察有无手术并发症、檀片透明度、内皮细胞密度和排斥反应等。结果1只眼术后发生植片半脱位，经再次前房注气后贴附良好。术后随访8～28个月，所有病例均未发生免疫排斥反应，植片保持透明，内皮细胞密度865～2410个／mm2。术后矫正视力恢复到好于穿透性角膜移植术后的最佳矫正视力。结论对于反复发生免疫排斥反应导致植片混浊的高危病例，EK可能是患者复明的较好选择。
Objective To report clinical resuhs of non-Descemet stripping automated endothelial keratoplasty（nDSAEK） to treat graft failure after penetrating keratoplasty. Methods It was a retrospective case series study. Five cases of grafts failure after penetrating keratoplasty （ PKP ） were enrolled in this study. All patients had a cloudy and swollen grafts, which thicker than 620 μm, and had foreign body sensation, vision decrease. Of this 5 cases, 4 of them are pseudophacie eye, 1 is aphaeic eye. One patient had previous vitrectomy, and 3 of them had one time history of PKP, 2 of them had twice PKP treatment. All cases were treated by nDSAEK, the nDSAEK grafts were prepared as a 200 μm thickness and 8. 00 to 8.75 mm in diameter by using hand or femtosecond laser asisted methods. The graft was inserted by forceps or suture pulling method through a 5.00 mm scleral tunel incision. Results One graft dislocated at 1 day postoperation, and was reattached by rebuble. All grafts keep clear during 8-28 months follow up period, and no immune rejection episodes were noted. The endothelial density were 865 to 2410/mm2. Postoperative best corrected vision （pBCVA） are better or equal to previous BCVA after pkp. Conclusion nDSAEK appears a good alternative surgical method for patients of grafts failure after pkp, especially for high risk patients of immune rejection.
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2012年第1期16-19,共4页
Chinese Journal of Ophthalmology
关键词
角膜后弹力层内皮移植术
假体失效
角膜移植术
穿透性
Deseemet stripping, endothelial keratoplasty
Prosthesis failure
Keratoplasty, penetrating
