CAJ | 학술논문

目的探讨不剥除后弹力层的角膜内皮移植术治疗虹膜角膜内皮综合征的角膜失代偿的可行性和临床疗效.方法回顾性非对照性系列病例研究.选择2008年1月至2009年12月在厦门大学附属厦门眼科中心住院的虹膜角膜内皮综合征的角膜失代偿7例患者,进行不剥除后弹力层的角膜内皮移植术.术后随访3～12个月,应用裂隙灯显微镜、前节相干光断层成像术、超声活体显微镜和激光共焦角膜显微镜观察植片透明度及植片贴附和植片移位等情况,应用角膜内皮细胞分析仪测量角膜内皮细胞密度,并对比手术前后的视力.结果术后无1例免疫排斥反应、植片移位及晶状体损伤发生.3例患者术后第2天出现继发性青光眼,给予20%甘露醇静脉滴注,3例术后第3天随前房空气的逐渐吸收而眼压下降.1例术后高眼压控制不佳,在术后2周行睫状体光凝术后眼压控制正常.7例患者植片均透明,激光共焦角膜显微镜显示术后供受体界面、供体角膜基质的高反光性随着时间明显下降,前节光学相干断层成像术及超声生物显微镜显示角膜内皮植片与受体内皮面贴附良好且虹膜及角膜内皮粘连分离.6例患者术后最佳矫正视力均有不同程度的提高;1例患者术后视力不提高的原因为青光眼性视神经萎缩.术后平均角膜内皮细胞密度为(2176.6±267.6)个/mm2.结论不剥除后弹力层的角膜内皮移植术治疗虹膜角膜内皮综合征的角膜失代偿具有安全、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 탐토불박제후탄력층적각막내피이식술치료홍막각막내피종합정적각막실대상적가행성화림상료효.방법 회고성비대조성계렬병례연구.선택2008년1월지2009년12월재하문대학부속하문안과중심주원적홍막각막내피종합정적각막실대상7례환자,진행불박제후탄력층적각막내피이식술.술후수방3～12개월,응용렬극등현미경、전절상간광단층성상술、초성활체현미경화격광공초각막현미경관찰식편투명도급식편첩부화식편이위등정황,응용각막내피세포분석의측량각막내피세포밀도,병대비수술전후적시력.결과 술후무1례면역배척반응、식편이위급정상체손상발생.3례환자술후제2천출현계발성청광안,급여20%감로순정맥적주,3례술후제3천수전방공기적축점흡수이안압하강.1례술후고안압공제불가,재술후2주행첩상체광응술후안압공제정상.7례환자식편균투명,격광공초각막현미경현시술후공수체계면、공체각막기질적고반광성수착시간명현하강,전절광학상간단층성상술급초성생물현미경현시각막내피식편여수체내피면첩부량호차홍막급각막내피점련분리.6례환자술후최가교정시력균유불동정도적제고;1례환자술후시력불제고적원인위청광안성시신경위축.술후평균각막내피세포밀도위(2176.6±267.6)개/mm2.결론 불박제후탄력층적각막내피이식술치료홍막각막내피종합정적각막실대상구유안전、유효、조작간편등특점,유망성위치료해병적수술방식지일.
Objective To investigate the feasibility and clinical effects of non-Descemet stripping endothelial keratoplasty ( nDSEK) on treating iridocomeal endothelial (ICE) syndrome in phakic eyes. Methods Retrospective noncomparative interventional case series. 7 patients (7 eyes) with ICE syndrome at the Affiliated Xiamen Eye Center of Xiamen University from January 2008 to December 2009 underwent non-Descemet stripping endothelial keratoplasty. All patients were followed up for 3-12 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-up period. Graft clearance and endothelial cell density(ECD) were observed, too. Results After nDSEK, no primary graft failures dislocation and decentered graft occurred during the follow-up period. Study group intraoperative complications included 3 case with elevated intraocular pressure 2 day postoperatively. Subepithelial haze, donor-recipient interface haze, and interface particles were observed in all measurable cases by in vivo laser confocal microscopy. Anteriorsegment optical coherence tomography and ultrasound biomicroscopy showed the adherence of the donor disc to the recipient endothelium and peripheral anterior synechiae were separated. All corneas remained clear during the follow-up. 6 patients had improved BCVA while 1 patient had the same BCVA. The reason for poor VA was optic atrophy due to glaucoma. Postoperative mean EDC was (2176. 6 ± 267. 6) cells/mm2. Conclusions nDSEK for iridocorneal endothelial (ICE) syndrome is feasible, technically easy, safe and effective. It can be one of the surgical treatment option for bullous keratopathy.