CAJ | 학술논문

目的研究对有晶状体眼患者进行缝线辅助角膜内皮移植手术的效果及并发症.方法回顾性系列病例研究.对2008年8月至2011年8月于北京大学第三医院进行有晶状体眼角膜内皮移植术的病例资料进行回顾性分析,记录患者角膜疾病及合并的眼部疾病情况,包括术前及术后12个月时远视力、近视力、眼压、中央前房深度、角膜厚度、角膜内皮细胞计数及手术并发症,所有患者随访12个月以上.结果共16例患者21只眼纳入研究,男性11例,女性5例,年龄2～47岁,诊断包括各种类型角膜内皮营养不良7只眼,大泡性角膜病变14只眼.患者术前远、近视力(LogMAR)分别为1.7±0.7、1.2±0.4,术后12个月时,远、近视力分别为0.8±0.6、0.7±0.5,Z值分别为-3.517,-2.764,分别为P ＜0.001(P=0.006).术前眼压为(15.8±3.7) mm Hg,术后眼压为(15.2±2.6)mm Hg,Z=-0.505,P=0.614.术前前房深度为(3.00±0.74) mm,术后前房深度为(2.72±0.59) mm,Z=-0.524,P=0.600.供体内皮细胞计数为(2992±163) cells/mm2,术后12个月时内皮细胞计数为(1836±412) cells/mm2,内皮细胞损失率约为39％.术后12个月时手术成功率为86％.手术并发症包括术后高眼压5只眼(24％),植片脱位3只眼(14％),植片偏位1只眼(5％).结论有晶状体眼角膜内皮移植术通过保留自身晶状体可以显著提高患者远视力及近视力,保留患者的调节功能,对于需要保留晶状体的患者是一种可选择的手术术式,术后需要重点防范瞳孔阻滞性高眼压.
목적 연구대유정상체안환자진행봉선보조각막내피이식수술적효과급병발증.방법 회고성계렬병례연구.대2008년8월지2011년8월우북경대학제삼의원진행유정상체안각막내피이식술적병례자료진행회고성분석,기록환자각막질병급합병적안부질병정황,포괄술전급술후12개월시원시력、근시력、안압、중앙전방심도、각막후도、각막내피세포계수급수술병발증,소유환자수방12개월이상.결과 공16례환자21지안납입연구,남성11례,녀성5례,년령2～47세,진단포괄각충류형각막내피영양불량7지안,대포성각막병변14지안.환자술전원、근시력(LogMAR)분별위1.7±0.7、1.2±0.4,술후12개월시,원、근시력분별위0.8±0.6、0.7±0.5,Z치분별위-3.517,-2.764,분별위P ＜0.001(P=0.006).술전안압위(15.8±3.7) mm Hg,술후안압위(15.2±2.6)mm Hg,Z=-0.505,P=0.614.술전전방심도위(3.00±0.74) mm,술후전방심도위(2.72±0.59) mm,Z=-0.524,P=0.600.공체내피세포계수위(2992±163) cells/mm2,술후12개월시내피세포계수위(1836±412) cells/mm2,내피세포손실솔약위39％.술후12개월시수술성공솔위86％.수술병발증포괄술후고안압5지안(24％),식편탈위3지안(14％),식편편위1지안(5％).결론 유정상체안각막내피이식술통과보류자신정상체가이현저제고환자원시력급근시력,보류환자적조절공능,대우수요보류정상체적환자시일충가선택적수술술식,술후수요중점방범동공조체성고안압.
Objective To investigate the outcomes and complications of suture pull-through insertion techniques for Descemet stripping automated endothelial keratoplasty (DSAEK)in Chinese phakic eyes.Methods Retrospective case series.Included in the study were all Chinese patients with phakic eyes who underwent DSAEK at Peking University Third Hospital from August 2008 to August 2011.All ocular diseases of the patients were recorded.Distance visual acuity (DVA),near visual acuity (NVA),intraocular pressure (IOP),anterior chamber depth (ACD),central corneal thickness (CCT),and corneal endothelial cell density (ECD) were compared prior to and 12 months after DSAEK.The DSAEK success rate,endothelial cell loss (ECL),complications,and prognosis were analyzed.All patients had at least 12 months of follow up.Results Twenty-one eyes of 16 patients were included (11 males and 5 females).Ages ranged from 2 to 47 years with an average age of 29.8 years.The average follow up was 15.4 months (ranging from 12 to 36 months).Diagnoses included 7 eyes (4 patients) with corneal endothelial dystrophy and 14 eyes (12 patients) with bullous keratopathy.Pre-surgical DVA and NVA (LogMAR) were 1.7 ± 0.7 and 1.2 ± 0.4; postsurgical DVA and NVA were 0.8±0.6 and 0.7±0.5; Z =-3.517,-2.764; P ＜0.001 and P =0.006 respectively.Pre-surgical IOP was 15.8±3.7 mmHg; postsurgical IOP was 15.2±2.6 mmHg; Z =-0.505,P =0.614.Pre-surgical ACD was 3.00±0.74 mm; postsurgical ACD was 2.72±0.59 mm; Z =-0.524,P =0.600.Donor ECD were 2992±163 cells/mm2,ECD were 1836±412 cells/mm2 with a 12-month postsurgical ECL of 39％.Success rate was 86％.Surgery complications included pupillary block-induced hypertension in 5 eyes (24％),graft detachment in 3 eyes (14％),and graft dislocation in 1 eye (5％).Conclusions DSAEK on Chinese phakic eyes can significantly improve DVA and NVA by preserving the patient's own crystalline lens.DSAEK is an optional surgery for patients who need to preserve accommodative function.More attention should be given to postsurgical pupillary block-induced hypertension.