CAJ | 학술논문

目的探讨大泡技术辅助的暴露后弹力层的深板层角膜移植(DALK)治疗深层化脓性角膜炎的初步临床疗效.方法回顾性病例系列研究.2011年1月至2012年3月,17例化脓性角膜炎角膜深层感染患者(溃疡或浸润深度超过4/5角膜厚度)在山东省眼科医院接受了DALK手术.手术方法:采用大泡技术辅助的方法切除病灶并暴露后弹力层,角膜植片较植床大0.25 mm,撕除后弹力层后缝合于植床.对围手术期并发症、术后复发、角膜植片透明、层间愈合、视力恢复等进行随访.结果手术后随访3 ～ 12个月,平均9个月.17例(17只眼)患者接受了DALK术,平均年龄(46±13)岁.真菌性角膜炎14例,细菌性角膜炎3例.2例患者术中发生微小穿孔,前房注入无菌空气后继续成功施行DALK术.术后3例患者出现双前房,2例自行吸收,1例行植片重缝术后缓解；1例患者术后复发,行穿透性角膜移植手术后控制.所有患者角膜植片均与植床贴附紧密,裂隙灯检查和眼前节相干光断层扫描检查难辨层间界面.所有角膜植片均透明.术前17例患者最佳矫正视力(BCVA)在20 cm眼前手动至3.7,手术后BCVA恢复至4.5～5.0.16例成功行DALK患者术后散光度数为(4.53±2.35)D.结论对于角膜深层感染的化脓性角膜炎患者,大泡技术辅助的暴露后弹力层的DALK术仍安全有效.
목적 탐토대포기술보조적폭로후탄력층적심판층각막이식(DALK)치료심층화농성각막염적초보림상료효.방법 회고성병례계렬연구.2011년1월지2012년3월,17례화농성각막염각막심층감염환자(궤양혹침윤심도초과4/5각막후도)재산동성안과의원접수료DALK수술.수술방법:채용대포기술보조적방법절제병조병폭로후탄력층,각막식편교식상대0.25 mm,시제후탄력층후봉합우식상.대위수술기병발증、술후복발、각막식편투명、층간유합、시력회복등진행수방.결과 수술후수방3 ～ 12개월,평균9개월.17례(17지안)환자접수료DALK술,평균년령(46±13)세.진균성각막염14례,세균성각막염3례.2례환자술중발생미소천공,전방주입무균공기후계속성공시행DALK술.술후3례환자출현쌍전방,2례자행흡수,1례행식편중봉술후완해；1례환자술후복발,행천투성각막이식수술후공제.소유환자각막식편균여식상첩부긴밀,렬극등검사화안전절상간광단층소묘검사난변층간계면.소유각막식편균투명.술전17례환자최가교정시력(BCVA)재20 cm안전수동지3.7,수술후BCVA회복지4.5～5.0.16례성공행DALK환자술후산광도수위(4.53±2.35)D.결론 대우각막심층감염적화농성각막염환자,대포기술보조적폭로후탄력층적DALK술잉안전유효.
Objective To evaluate the clinical results of deep anterior lamellar keratoplasty (DALK) assisted by big bubble technique in the treatment of deep infectious purulent keratitis.Methods Seventeen patients (17 eyes) with deep infectious purulent keratitis received DALK surgery in Shandong Eye Hospital from January 2011 to March 2012.Case selection:Patients with purulent keratitis,the infection or infiltrate depth was more than four fifth corneal thickness; Surgical technique:Use DALK assisted by big bubble technique to cut off the lesions and expose the Descemet's membrane.The prepared donor which stored in D-X medium or in glycerine preoperatively was oversized by 0.25 mm,and after stripping of Descemet's membrane,the donor button was interrupted sutured with 10-0 nylon suture.The perioperative complications,recurrence,graft status and visual recovery were evaluated.Results The mean follow up time were 9 months.17 patients with average age of (46 ± 13) year old received DALK surgery,including 14 cases of fungal keratitis and 3 cases of bacteria keratitis.Perioperative complications:Two cases suffered micro perforation and were continuing performed DALK surgery after injecting air bubble in the anterior chamber.Three cases suffered double anterior chamber,one was resolved after graft resuture,and the other two were absorbed automatically.One patient suffered fungal recurrence and cured with secondary penetrating keratoplasty.Graft status:All grafts attached closely to the recipients,slit lamp and AS-OCT examinations were difficult to distinguish the interface.All of grafts were transparent.Visual acuity:before the operation best corrected visual acuity (BCVA) in patients with HM/20 cm to 3.7,after the surgery patients' BSCVA improved to 4.5-5.0.The mean astigmatism postoperatively of 16 cases received successful DALK finally was (4.53 ± 2.35) D.Conclusions For patients with deep infectious purulent keratititis,big bubble technique assistanted DALK surgery is still a safe and effective method.