CAJ | 학술논문

目的探讨在无晶状体眼后弹力层剥除内皮移植术(DSEK)中采用临时锚状缝线固定内皮植片的可行性、疗效及并发症.方法回顾性系列病例研究.2007年4至12月期间中山大学中山眼科中心对12例(12只眼)无晶状体眼大泡性角膜病变患者采用临时锚状缝线固定内皮植片进行后弹力层剥除内皮移植术.12例患者均为白内障术后,最佳矫正视力(BSCVA)均低于或等于0.04,8例有眼痛.术前与术后3、6及12个月行BSCVA、角膜散光、角膜曲率、角膜厚度测量,术后6和12个月行角膜内皮显微镜检查.术后随访12～20个月.结果 12例患者均顺利行DSEK.术后12只术眼植片均位于受体植床中央,无植片移位.术后第1天,2例患者出现瞳孔阻滞性青光眼,予20%甘露醇静脉滴注,术后第2天,随前房中空气减少眼压降至正常.术后12只术眼内皮植片均出现轻至中度水肿,术后8～15 d,植片恢复透明.随访期间,12只术眼角膜均透明.术后12个月,有2例BSCVA为0.7,有3例为0.5,有4例为0.4,有3例为0.3.术后12个月,平均角膜散光度数为(2.40±0.70)D,平均角膜曲率为(45.40±1.50)D,平均角膜厚度为(591.5±20.4)μm.术后6和12个月,平均角膜内皮细胞密度分别为(2088±146)个/mm~2和(1857±101)个/mm~2,内皮细胞损失率分别为(28.9±3.9)%和(36.7±3.1)%.结论临时锚状缝线能有效地固定内皮植片,防止植片移位和滑入玻璃体腔.
목적 탐토재무정상체안후탄력층박제내피이식술(DSEK)중채용림시묘상봉선고정내피식편적가행성、료효급병발증.방법 회고성계렬병례연구.2007년4지12월기간중산대학중산안과중심대12례(12지안)무정상체안대포성각막병변환자채용림시묘상봉선고정내피식편진행후탄력층박제내피이식술.12례환자균위백내장술후,최가교정시력(BSCVA)균저우혹등우0.04,8례유안통.술전여술후3、6급12개월행BSCVA、각막산광、각막곡솔、각막후도측량,술후6화12개월행각막내피현미경검사.술후수방12～20개월.결과 12례환자균순리행DSEK.술후12지술안식편균위우수체식상중앙,무식편이위.술후제1천,2례환자출현동공조체성청광안,여20%감로순정맥적주,술후제2천,수전방중공기감소안압강지정상.술후12지술안내피식편균출현경지중도수종,술후8～15 d,식편회복투명.수방기간,12지술안각막균투명.술후12개월,유2례BSCVA위0.7,유3례위0.5,유4례위0.4,유3례위0.3.술후12개월,평균각막산광도수위(2.40±0.70)D,평균각막곡솔위(45.40±1.50)D,평균각막후도위(591.5±20.4)μm.술후6화12개월,평균각막내피세포밀도분별위(2088±146)개/mm~2화(1857±101)개/mm~2,내피세포손실솔분별위(28.9±3.9)%화(36.7±3.1)%.결론 림시묘상봉선능유효지고정내피식편,방지식편이위화활입파리체강.
Objective To investigate the feasibility,efficacy,and complications of the temporary anchor sutures for endothelial graft fixation in Descemet stripping endothelial keratoplasty (DSEK) in aphakic eyes.Methods Non-randomized retrospective case series.Twelve consecutive cases (12 eyes)with aphakic bullous keratopathy underwent DSEK using the temporary anchor sutures technique for fixation of donor button in Zhongshan Ophthalmic Center between April to December in 2007.All cases were resulted from lens extraction and best spectacle-corrected visual acuity (BSCVA) was inferior or equal to 0.04.Eight cases were with preoperative pain. Prospective data of BSCVA,corneal astigmatism,curvature and thickness were collected on all 12 eyes preoperatively and at 3,6 and 12 months postoperatively.Average endothelial cell density (ECD) and endothelial cell loss (ECL) were recorded at 6 and 12 months postoperatively.The follow-up period was 12 to 20 months.Results All cases were performed DSEK successfully using the temporary anchor sutures and the grafts were well-attached without dislocation.On postoperative day 1,papillary block glaucoma occurred in 2 eyes and mannitol 20% was administered intravenously.The intraocular pressure in the 2 eyes returned to normal due to the air burble absorption on postoperative day 2.The endothelial grafts showed mild to moderate edema in all eyes and became clear in 8 to 15 days postoperatively.all the corneas were clear during follow-up.In 12 months postoperatively,BSCVA was 0.7 in 16.7% of eyes (n=2),0.5 in 25.0%of eyes(n=3),0.4 in 33.3% of eyes(n=4),and 0.3 in 25.0%of eyes(n=3);mean corneal astigmatism was(2.40±0.70) diopters,mean corneal curvature was (45.40±1.50) diopters,and mean corneal thickness was (591.5±20.4) μm. Mean endothelial cell density (ECD) was (2088±146)cells/mm~2[(28.9±3.9)% endothelial cell loss] and (1857±101)cells/mm~2[(36.7±3.1)% endothelial cell loss] in 6 and 12 months postoperatively,respectively.Conclusion The temporary anchor sutures technique was easy to perform and effectively prevented graft dislocation and detachment into the vitreous cavity.