CAJ | 학술논문

目的探讨反板层角膜移植治疗大泡性角膜病变、Terien's角膜变性及对眼化学伤急救处理的疗效。方法大泡性角膜病变20眼，Terrien's角膜变性12眼，眼化学伤10眼，术中切除病变的角膜板层组织，同时将甘油冷冻保存的反板层角膜植片复水，将处理后的植片后弹力层向上，粗糙的基质层向下，用10-0尼龙线间断或连续缝合，植片的直径较植床大0.5～1.0mm。结果除1眼(化学伤)发生排斥反应外，其余41眼反板层植片在术后一段时间内(2～4wk)经历不同程度的水肿阶段后，都能与植床紧密贴合，随访1～5a，植片保持半透明甚至透明状态。其中大泡性角膜病变20眼疼痛症状完全消失；12例Terrien's角膜变性中11眼术后4wk视力明显改善(视力表检查提高2～3行)；10例眼化学伤中4眼视力明显改善(视力表检查提高2～3行)。结论反板层角膜移植可成功应用于治疗大泡性角膜病变、Terrien's角膜变性及眼化学伤的急救处理，疗效满意。
목적탐토반판층각막이식치료대포성각막병변、Terien's각막변성급대안화학상급구처리적료효。방법대포성각막병변20안，Terrien's각막변성12안，안화학상10안，술중절제병변적각막판층조직，동시장감유냉동보존적반판층각막식편복수，장처리후적식편후탄력층향상，조조적기질층향하，용10-0니룡선간단혹련속봉합，식편적직경교식상대0.5～1.0mm。결과제1안(화학상)발생배척반응외，기여41안반판층식편재술후일단시간내(2～4wk)경력불동정도적수종계단후，도능여식상긴밀첩합，수방1～5a，식편보지반투명심지투명상태。기중대포성각막병변20안동통증상완전소실；12례Terrien's각막변성중11안술후4wk시력명현개선(시력표검사제고2～3행)；10례안화학상중4안시력명현개선(시력표검사제고2～3행)。결론반판층각막이식가성공응용우치료대포성각막병변、Terrien's각막변성급안화학상적급구처리，료효만의。
Objective　To evaluate the therapeutic efficiency of reversed lamellar keratoplasty for bullous keratopathy, Terrien's marginal degeneration and ocular chemical burns.Methods　Twenty eyes of patients with bullous keratopathy, twelve eyes with Terrien's marginal degeneration, ten eyes with chemical burns were recruited in this study.Diseased tissues were removed by means of dissection.Reversed lamellae corneal tissues which had been prepared by cryopreservation were thawed and rinsed. Then the prepared posterior corneal lamellae was turned over, endothelium facing upwards. The diameter of the graft should be 0.5～1.0mm larger than that of the recipient bed. The reversed donor posterior lamellae was sutured into the host keratectomy bed with 10-0 nylon sutures continuously or interruptedly.Results　Allograft reaction episode occurred only one (chemical burn) of the total 42 eyes enrolled.The grafts of the rest 41 eyes maintained clear or semitransparent for 1～5 years. Graft edema could be observed within 2～4 weeks postoperatively. Postoperative interface separation was not found. For all 20 patients with bullous keratopathy, the symptoms of pain disappeared. The visual acuity improved 2～3 lines of Snellen among eleven of twelve patients with Terrien's marginal degeneration. The visual acuity improved 2～3 lines of Snellen with four patients with chemical burns.Conclusion　The technique of reversed lamellar keratoplasty can be applied successfully for tectonic reconstruction of corneal surface such as bullous keratopathy, Terrien' s marginal degeneration and also chemical burns.The effects of therapy was satisfactory.