CAJ | 학술논문

前部深板层角膜移植术(deep anterior lamellar keratoplasty,DALK)是一种新的角膜移植技术,该技术将去除后弹力层和内皮层的供体角膜移植到去除全部基质的植床上,以期望获得与穿透角膜移植术相同的光学效果,同时减少术中和术后并发症.DALK对手术技术要求高,关键步骤是暴露后弹力层.暴露后弹力层的方法经历了直接分离法、基质无菌空气辅助分离法、水分离法、黏弹剂法、大泡技术等,这些技术在不断改进且日趋成熟.DALK的优点是保留了眼球结构和免疫的相对完整性,可减少术后内皮型免疫排斥反应、角膜植片慢性功能失代偿以及角膜植片因外伤哆开的风险.本文就DALK的适应证、手术技术和并发症等进行综述,为其技术改进和广泛临床应用提供思路.
전부심판층각막이식술(deep anterior lamellar keratoplasty,DALK)시일충신적각막이식기술,해기술장거제후탄력층화내피층적공체각막이식도거제전부기질적식상상,이기망획득여천투각막이식술상동적광학효과,동시감소술중화술후병발증.DALK대수술기술요구고,관건보취시폭로후탄력층.폭로후탄력층적방법경력료직접분리법、기질무균공기보조분리법、수분리법、점탄제법、대포기술등,저사기술재불단개진차일추성숙.DALK적우점시보류료안구결구화면역적상대완정성,가감소술후내피형면역배척반응、각막식편만성공능실대상이급각막식편인외상치개적풍험.본문취DALK적괄응증、수술기술화병발증등진행종술,위기기술개진화엄범림상응용제공사로.
Deep anterior lamellar keratoplasty (DALK) is a new keratoplasty technique,which transplants a partial thickness donor cornea bared of its Descemet's membrane and endothelium onto a recipient bed after full removal of recipient stromal tissue,in order to provide similar visual outcome with penetrating keratoplasty as well as to decrease intraoperative and postoperative complications.This surgical procedure is technically challenging and the critical step is to bare Descemet's membrane.The ways to bare Descemet's membrane have experienced direct open dissection,intrastromal air injection dissection,hydrodelamination dissection,viscoelastic dissection,big bubble technique,etc..These techniques are being constantly improved to perfect.The advantage of DALK is that it relatively preserves both structural and immunological integrity of the eye,thus decreasing the risk of endothelial graft rejection,chronic corneal allograft dysfunction and traumatic wound dehiscence.This review focuses on the indications,different techniques and complications of DALK,aiming at providing ways to promote its technological improvement and widely clinical application.