CAJ | 학술논문

目的探讨角膜后弹力层剥除自动角膜刀取材内皮移植术(DSAEK)联合超声乳化白内障吸除及人工晶状体置换手术治疗角膜内皮失代偿并有白内障或人工晶状体异常患者的疗效和并发症情况.方法回顾性临床自身对照研究.对2007年12月至2008年12月在北京大学第三医院就诊的各种原因引起的角膜内皮失代偿合并有晶状体异常的患者18例(20只眼)分别行DSAEK联合超声乳化白内障吸除人工晶状体植入手术5例(7只眼)、DSAEK联合前房型人工晶状体取出与前段玻璃体切除及后房型人工晶状体悬吊术7例(7只眼)或DSAEK联合前段玻璃体切除及后房型人工晶状体悬吊术6例(6只眼).术后观察视力、角膜透明性的恢复、植片厚度、角膜内皮细胞丢失、植片的脱位率及排斥反应发生情况.采用治疗前后均数比较t检验.结果术后18例患者眼部刺激症状均消除,角膜水肿全部消退,术前和术后的角膜厚度分别为859μm、553 μm,差异有统计学意义(t=5.303,P＜0.01);术前供体角膜内皮细胞密度为2987个/mm2,术后3个月角膜内皮细胞密度为1803个/mm2,内皮细胞丢失率为41%.术后除去患有眼底病变的患者9只眼,其余患者视力均有大幅度的提高,视力恢复到0.8以上的有6只眼,在眼底正常的患者中占55%(6/11).术后前房人工晶状体眼炎症反应最重,其余患者反应轻微;术后有6只眼植片脱位(30%,6/20)、术后5例出现眼压升高、1例发生植片排斥反应,均为前房人工晶状体眼的患者.结论 DSAEK联合超声乳化白内障吸除及人工晶状体置换手术对于治疗角膜内皮失代偿并有晶状体或人工晶状体异常患者是一种较安全、有效的手术方法.前房人工晶状体眼行DSAEK术后并发症较多,对虬膜、房角结构异常的患者行角膜内皮移植手术应谨慎.
목적 탐토각막후탄력층박제자동각막도취재내피이식술(DSAEK)연합초성유화백내장흡제급인공정상체치환수술치료각막내피실대상병유백내장혹인공정상체이상환자적료효화병발증정황.방법 회고성림상자신대조연구.대2007년12월지2008년12월재북경대학제삼의원취진적각충원인인기적각막내피실대상합병유정상체이상적환자18례(20지안)분별행DSAEK연합초성유화백내장흡제인공정상체식입수술5례(7지안)、DSAEK연합전방형인공정상체취출여전단파리체절제급후방형인공정상체현조술7례(7지안)혹DSAEK연합전단파리체절제급후방형인공정상체현조술6례(6지안).술후관찰시력、각막투명성적회복、식편후도、각막내피세포주실、식편적탈위솔급배척반응발생정황.채용치료전후균수비교t검험.결과 술후18례환자안부자격증상균소제,각막수종전부소퇴,술전화술후적각막후도분별위859μm、553 μm,차이유통계학의의(t=5.303,P＜0.01);술전공체각막내피세포밀도위2987개/mm2,술후3개월각막내피세포밀도위1803개/mm2,내피세포주실솔위41%.술후제거환유안저병변적환자9지안,기여환자시력균유대폭도적제고,시력회복도0.8이상적유6지안,재안저정상적환자중점55%(6/11).술후전방인공정상체안염증반응최중,기여환자반응경미;술후유6지안식편탈위(30%,6/20)、술후5례출현안압승고、1례발생식편배척반응,균위전방인공정상체안적환자.결론 DSAEK연합초성유화백내장흡제급인공정상체치환수술대우치료각막내피실대상병유정상체혹인공정상체이상환자시일충교안전、유효적수술방법.전방인공정상체안행DSAEK술후병발증교다,대규막、방각결구이상적환자행각막내피이식수술응근신.
Objective To evaluate the effect and explore the complications of Descemet-stripping automated endothelial keratoplasty (DSAEK) combined with phacoemulcification cataract surgery or lens exchange in corneal endothelial dysftnction eyes with lens disorders. Methods Retrospective case series.Eighteen consecutive cases (20 eyes) were performed DSAEK combined with lens surgery from December 2007 to December 2008 in Department of Ophthalmology, Peking University Third Hospital. Five cases (7 eyes) were performed DSAEK combined with phacoemulcification and intraocular lens (IOL) insertion.Seven cases were combined with anterior chamber IOL extraction, anterior vitrectomy and posterior chamber IOL insertion. Six aphakia cases were performed with DSAEK combined with anterior vitrectomy and sclera fixation posterior chamber IOL insertion. Postoperatively, the visual acuity, corneal transparency, central corneal thickness (CCT), endothelial cell density (ECD) and complications were observed during the follow-up. Results The irritation was disappeared in all of patients. All of the corneas became transparent.The preoperative and postoperative mean CCT of the recipient beds was 859 μm and 553 μm respectively. T value was 5.303 ( t = 5.303, P ＜ 0.01 ). It was extremely significant difference. The mean ECD of the donors was 2987 cells/mm2. The ECD was 1803 cells/mm2 in three months postoperatively. The rate of endothelial cells loss was 41%. The visual acuity improved significantly except 9 eyes which had fundus disorders. Six eyes were better than 0.8. It was 55% in normal retinal function patients (6/11). The inflammatory reaction of the anterior chamber IOL eyes was most serious. Six eyes underwent graft dislocation. Five cases underwent high intraocular pressure. One case occurred graft rejection.These complications occurred in anterior chamber IOL eyes. Conclusions DSAEK combined with phacoemulcification cataract surgery or lens exchange is a safe and effective surgical treatment for corneal endothelial dysfunction with lens disorders. More complications occur in anterior chamber IOL eyes. DSAEK should be cautiously chosen in abnormal iris and chamber angle structural eyes.