CAJ | 학술논문

目的应用前节OCT (AS-OCT)研究不撕除后弹力层的角膜内皮移植术(nDSEK)术后角膜厚度,角膜结构功能的改变.方法回顾性临床研究.收集2007年9月至2011年9月在厦门大学附属厦门眼科中心行nDSEK的20例的角膜内皮病变患者(男9例,女11例),平均年龄(57±20)岁.采用裂隙灯显微镜、前节OCT分别在术前,术后第7天及术后第1、3、6、12、24、36个月,对角膜形态进行连续对比观察.观察的指标包括:角膜中央厚度(包括植床和角膜内皮植片),板层积液以及植片移位等情况.结果平均随访(30±9)个月,所有患者角膜内皮植片与受体内皮面贴附良好.前节OCT显示20例患者术前角膜中央厚度平均值为:(679±124) μm,术后1周角膜中央平均厚度达(1012±124)μm,角膜植片平均厚度为(208±42) μm,在术后1周到术后3个月角膜厚度明显下降.角膜厚度的改变与内皮细胞功能的恢复有关.在nDSEK术后l周至1个月角膜厚度明显降低,变化速率为6.3 μm/d,术后1～3个月(30天)降低至1.6 μm/d,3～12个月为5.4 μm/月c内皮植片在术后1个月厚度降低明显,1.5μm/天,1个月后植片厚度保持稳定.结论 nDSEK术后角膜内皮功能恢复快,角膜厚度在术后1个月明显降低,3个月后趋于稳定.前节OCT可有效评估nDSEK术后植片内皮细胞功能恢复情况及植床和植片位置关系.
목적 응용전절OCT (AS-OCT)연구불시제후탄력층적각막내피이식술(nDSEK)술후각막후도,각막결구공능적개변.방법 회고성림상연구.수집2007년9월지2011년9월재하문대학부속하문안과중심행nDSEK적20례적각막내피병변환자(남9례,녀11례),평균년령(57±20)세.채용렬극등현미경、전절OCT분별재술전,술후제7천급술후제1、3、6、12、24、36개월,대각막형태진행련속대비관찰.관찰적지표포괄:각막중앙후도(포괄식상화각막내피식편),판층적액이급식편이위등정황.결과 평균수방(30±9)개월,소유환자각막내피식편여수체내피면첩부량호.전절OCT현시20례환자술전각막중앙후도평균치위:(679±124) μm,술후1주각막중앙평균후도체(1012±124)μm,각막식편평균후도위(208±42) μm,재술후1주도술후3개월각막후도명현하강.각막후도적개변여내피세포공능적회복유관.재nDSEK술후l주지1개월각막후도명현강저,변화속솔위6.3 μm/d,술후1～3개월(30천)강저지1.6 μm/d,3～12개월위5.4 μm/월c내피식편재술후1개월후도강저명현,1.5μm/천,1개월후식편후도보지은정.결론 nDSEK술후각막내피공능회복쾌,각막후도재술후1개월명현강저,3개월후추우은정.전절OCT가유효평고nDSEK술후식편내피세포공능회복정황급식상화식편위치관계.
Objective To evaluate the thickness of cornea and the function of cornea and graft with AS-OCT after non-descemet stripping endothelial keratoplasty.Methods Single-center,prospective,no comparative,interventional case series.All 20 patients,from September 2007 to September 2011 (9 male,11 female) were treated with non-DSEK for bullous keratoplasty,endothelial dysfunction and iridoCorneal endothelial syndrome (ICE) in Xiamen eye center affiliated to Xiamen university.Central corneal thickness,interface fluid and dislocation of graft were measured with AS-OCT during the follow up of 36 months containing preoperative 7 days and 1,3,6,12,24,and 36 months after operation.Results Preoperative average central corneal thickness (CCT) was 718um.From 7 days to 1 month CCT changed significantly.As known the dynamics of CCT was correlated with the change of recipient and graft.Cornea decreased at speed of 10.4um/day within the first week and 5.7um/day during the first month postoperative.During 1 and 36 months the cornea was more stable with only a trend toward further decrease,at speed of 5.6um/month.Conclusions Corneal thickness has changed notably since the 1 month and turned more stable since the 3rd month.AS-OCT can monitor cornea dynamics quantitatively and tell the recovery of endothlieal cell.