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(Descemet's stripping with automatedendothelial keratoplasty,DSAEK)术后植片脱位的原因和处理的方法.方法回顾性研究,在接受DSAEK的48只眼中发生植片脱位的有10例患者,其中2例为晶体摘除后无晶体眼无后囊的病例、8例为人工晶状体眼虹膜缺损的病例.7例患者既往有青光眼的病史.DSAEK术后应用裂隙灯显微镜和前节OCT观察植片的位置.植片复位的方法有气泡复位法和黏弹剂复位法,即将气泡或黏弹剂注入到植片的下方,将植片顶起与植床相贴.结果 10例患者全部复位成功,其中2例晶体缺如但虹膜正常的患者应用气泡复位成功;另8例人工晶状体眼虹膜缺损的患者应用黏弹剂复位成功.术后早期所有患者眼压均正常,但有3例患者复位手术3周后发生眼压升高.结论 DSAEK术后植片脱位是最常见的并发症,气泡复位是最常应用的方法,但对于晶体虹膜隔异常的患者,黏弹剂复位是一种有效地手段.
목적 탐토각막후탄력층박제자동각막도취재내피이식(Descemet's stripping with automatedendothelial keratoplasty,DSAEK)술후식편탈위적원인화처리적방법.방법 회고성연구,재접수DSAEK적48지안중발생식편탈위적유10례환자,기중2례위정체적제후무정체안무후낭적병례、8례위인공정상체안홍막결손적병례.7례환자기왕유청광안적병사.DSAEK술후응용렬극등현미경화전절OCT관찰식편적위치.식편복위적방법유기포복위법화점탄제복위법,즉장기포혹점탄제주입도식편적하방,장식편정기여식상상첩.결과 10례환자전부복위성공,기중2례정체결여단홍막정상적환자응용기포복위성공;령8례인공정상체안홍막결손적환자응용점탄제복위성공.술후조기소유환자안압균정상,단유3례환자복위수술3주후발생안압승고.결론 DSAEK술후식편탈위시최상견적병발증,기포복위시최상응용적방법,단대우정체홍막격이상적환자,점탄제복위시일충유효지수단.
Objective To survey the management of dislocaed graft after Descemet' s Stripping with Automated Endothelium Keratoplasty (DSAEK).To provide experience for DSAEK developing in china. Method Outcomes of 48 DSAEK cases were reviewed retrospoctively.10 patients had dislocation of donor graft after DSAEK.Among these, 2 patients were aphakic with integrity iris, while 8 patients were pseudophakic with iris defect.7 patients had history of glaucoma.The position of the graft was checked by slit-lamp microscopy and anterior segment optical coherence tomogmphy.The methods of reposition included bubble and viscoelastic, the procedure was that bubble or viscoelastic was injected to appose the graft further to the recipient sufface.Resttlts 10 patients were successfully repositioned.The rebubbling was applied in 2 aphakic cases and the viscoelastic was done in 8 cases who pseudophakic with iris defect.The intraocular pressure (IOP) was normal in 2 week post-reposition in all patients.3 patients occurred high LOP 3 week post-reposition.Conclusions The most complication is dislocation of graft in DSAEK.Rebubbling to reposition graft is a regular method in normal structure eyes, but viscoelastic reattaching the dislocated graft is effective way in abnormal structure eyes after DSAEK.