CAJ | 학술논문

目的探讨小切口下角膜后弹力层剥除联合深板层内皮移植术(DSEK)的手术方法、疗效、并发症、内皮细胞的评价及组织学检查.方法为实验研究.将24只新西兰大白兔随机分为3组,每组8只兔(8只眼),供体为新西兰大白兔16只眼.A组于角膜缘处行5 mm长隧道切口,剥去角膜中央直径10 mm的后弹力层,将等大的带有少量基质的后弹力层内皮细胞膜片植入受体眼;B组行单纯角膜后弹力层环形撕除术;C组在角膜后弹力层剥除后行去内皮细胞的带少许角膜基质和后弹力层膜片植入.术后观察1个月,比较3组兔角膜的透明性、植片贴附情况、角膜内皮细胞密度及并发症情况.结果 A组8只眼术前角膜内皮细胞密度平均值为(2728±108)个/mm2,术后角膜均恢复透明,内皮细胞密度平均为(2195±77)个/mm2,差异有统计学意义(t=12.455,P＜0.001);组织切片证实角膜内皮细胞植片与受体植床愈合良好,层间无瘢痕形成.B组8只眼术后均有严重的角膜水肿,持续1个月未恢复,组织学检查术后28 d时仅在后弹力层剥除的交界处有极少数的内皮细胞长入.C组8只眼术后1周内角膜植片均水肿,5只眼植片脱位;术后至观察1个月,角膜中央水肿仍较明显,伴有角膜新生血管长入,组织学检查植片部位未见内皮细胞长入.结论角膜后弹力层剥除联合深板层内皮移植术具有安全、损伤小、术后恢复快及无层间瘢痕的优点,是治疗大泡性角膜疾病的优选术式.
목적 탐토소절구하각막후탄력층박제연합심판층내피이식술(DSEK)적수술방법、료효、병발증、내피세포적평개급조직학검사.방법 위실험연구.장24지신서란대백토수궤분위3조,매조8지토(8지안),공체위신서란대백토16지안.A조우각막연처행5 mm장수도절구,박거각막중앙직경10 mm적후탄력층,장등대적대유소량기질적후탄력층내피세포막편식입수체안;B조행단순각막후탄력층배형시제술;C조재각막후탄력층박제후행거내피세포적대소허각막기질화후탄력층막편식입.술후관찰1개월,비교3조토각막적투명성、식편첩부정황、각막내피세포밀도급병발증정황.결과 A조8지안술전각막내피세포밀도평균치위(2728±108)개/mm2,술후각막균회복투명,내피세포밀도평균위(2195±77)개/mm2,차이유통계학의의(t=12.455,P＜0.001);조직절편증실각막내피세포식편여수체식상유합량호,층간무반흔형성.B조8지안술후균유엄중적각막수종,지속1개월미회복,조직학검사술후28 d시부재후탄력층박제적교계처유겁소수적내피세포장입.C조8지안술후1주내각막식편균수종,5지안식편탈위;술후지관찰1개월,각막중앙수종잉교명현,반유각막신생혈관장입,조직학검사식편부위미견내피세포장입.결론 각막후탄력층박제연합심판층내피이식술구유안전、손상소、술후회복쾌급무층간반흔적우점,시치료대포성각막질병적우선술식.
Objective To investigate the surgical procedure,clinical efficacy,complications,density of endothelial cells and histological changes after Descemet's stripping endothelial keratoplasty (DSEK)surger.Methods It was a experimental study.Twenty four New Zealand rabbits were divided into 3 groups,8 rabbits per group.Donor grafts were dissected from 16 New Zealand rabbit eyes.Group A Was experimental group,a 5 mm limbal tunnel incision was made.Descemet's membrane was striped off at 10 mm diameter,then the same diameter donor cornea(including Descemet's membrane and endothelium with a little of posterior stroma)was inserted into the recipient's anterior chamber.Air was injected into the anterior chamber to press the graft up against the recipient cornea. Group B was the control group,only striped the Descemet's membrane at the recipient cornea. Group C was the experiment control group,the procedure was similar to the group A,but the donor graft was without endothelial cells. Results All corneas of group A were transparent,and the mean density of the endothelial cells was(2195 ± 77)/mm2(t=12.455,P＜0.001).Endothelial grafts attached to the recipients well and no scar formation between them under histological observation.The corneas were severe edema in groups B and C one month after surgery.Conclusions DSEK is a safe surgery,can be recovered rapidly with little damages,and without interface scale formation after surgery.DSEK may be the first choice for the treatment of bullous keratopathy.