CAJ | 학술논문

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8.00～8.75 mm.用植入镊或缝线牵引法,经巩膜隧道5.00 mm切口植入.术后常规处理,观察有无手术并发症、植片透明度、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.
목적 관찰각막내피이식수술(EK)치료천투성각막이식수술(PKP)후식편실대상적림상효과.방법 회고성병례연구.수집자2008년8월지2010년10월,재애이안과의원집단인불동원인접수PKP수술,술후인면역배척반응도치식편내피실대상적환자자료5례.소유병례채취불시제후탄력층적EK술.공체식편채취수공박판층혹용비초격광제작,후도200μm좌우,직경8.00～8.75 mm.용식입섭혹봉선견인법,경공막수도5.00 mm절구식입.술후상규처리,관찰유무수술병발증、식편투명도、내피세포밀도화배척반응등.결과 1지안술후발생식편반탈위,경재차전방주기후첩부량호.술후수방8 ～28개월,소유병례균미발생면역배척반응,식편보지투명,내피세포밀도865 ～ 2410개/mm2.술후교정시력회복도호우천투성각막이식술후적최가교정시력.결론 대우반복발생면역배척반응도치식편혼탁적고위병례,EK가능시환자복명적교호선택.
Objective To report clinical results 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 pseudophacic eye,1 is aphacic 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 lday 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.