CAJ | 학술논문

目的探讨不剥除后弹力层的深板层角膜内皮移植术治疗大泡性角膜病变的可行性和临床疗效.方法前瞻性系列病例研究,收集自2007年9月至2009年1月在我院住院的大泡性角膜病变患者,进行不剥除后弹力层的深板层角膜内皮移植术.术中均未处理患眼角膜内皮.直接用植入镊将制作好的直径为8.5mm的角膜内皮植片植入受体前房,气体顶压植片进行固定.术后随访6～20个月,观察植片贴附和植片移位等情况,对手术前后的视力进行比较,检查植片透明度和角膜内皮细胞密度.结果 5例患者术后植片与受体内皮面始终贴附良好;1例患者术后第2天出现层间裂隙,经改俯卧位后植片贴附良好.6例患者植片均透明,其中5例患者术后最佳矫正视力均有不同程度的提高;1例患者术后视力同术前,视力不提高的原因为眼外伤造成的视神经萎缩.6例术后平均角膜内皮细胞密度为(1648±384)个/mm~2.随访过程均未发现有免疫排斥反应发生.结论不剥除后弹力层的深板层角膜内皮移植术治疗大泡性角膜病变具有安全、有效、操作简便等特点,有望成为治疗该病的手术方式之一.
목적 탐토불박제후탄력층적심판층각막내피이식술치료대포성각막병변적가행성화림상료효.방법 전첨성계렬병례연구,수집자2007년9월지2009년1월재아원주원적대포성각막병변환자,진행불박제후탄력층적심판층각막내피이식술.술중균미처리환안각막내피.직접용식입섭장제작호적직경위8.5mm적각막내피식편식입수체전방,기체정압식편진행고정.술후수방6～20개월,관찰식편첩부화식편이위등정황,대수술전후적시력진행비교,검사식편투명도화각막내피세포밀도.결과 5례환자술후식편여수체내피면시종첩부량호;1례환자술후제2천출현층간렬극,경개부와위후식편첩부량호.6례환자식편균투명,기중5례환자술후최가교정시력균유불동정도적제고;1례환자술후시력동술전,시력불제고적원인위안외상조성적시신경위축.6례술후평균각막내피세포밀도위(1648±384)개/mm~2.수방과정균미발현유면역배척반응발생.결론 불박제후탄력층적심판층각막내피이식술치료대포성각막병변구유안전、유효、조작간편등특점,유망성위치료해병적수술방식지일.
Objective To investigate the feasibility and clinical effect of non-Descemet stripping endothelial keratoplasty for bullous keratopathy.Methods In the prospective consecutive case series,6 patients (6 eyes) with bullous keratopathy at Affiliated Xiamen Eye Center of Xiamen University from September 2007 to January 2009 underwent non-Descemet stripping endothelial keratoplasty.During the surgical procedures.the recipient's Descemet membrane and endothelial layer were left untreated.The donor tissue disc consisting of posterior stroma and healthY endothelium from a donor cornea was implanted into the anterior chamber from a limbal tunnel incision,then unfolded and pressed against the recipient cornea with sterile air filled in anterior chamber.All patients were followed up for 6-20 months,pre-and postoperative best corrected visual acuity (BCVA) were compared,the adherence of the donor disc to the recipient endothelium and postoperative donor disc dislocation were monitored during the follow-uD period.Graft clearance and endothelial cell density (ECD) were observed,too.Results Five donor disc were well adhered to the recipient endothelium and no graft dislocation occurred during the follow-up period.One case showed a narrow gap between the host endothelium and donor disc 1 day postoperatively.This patient was told to stay in prone position and the donor disc readhered well.All the grafts remained transparent until the latest follow-up.Five patients had improved BCVA while 1 patient had the same BCVA.The reason for poor VA was optic atrophy due to trauma.Postoperative mean EDC was (1648±384) cells/mm~2.Conclusions Non-Descemet stripping endothelial keratoplasty for bullous keratopathy is feasible,technically easy,safe and effective.It can be one of the surgical treatment option for bullous keratopathy.