CAJ | 학술논문

目的总结角膜后弹力层剥除自动板层刀角膜内皮移植术(DSAEK)的并发症及处理方法.方法回顾性病例研究.对2007年9月至2009年2月在北京大学第三医院眼科中心接受DSAEK的42例患者(47只眼)进行总结.引起角膜内皮失代偿的原因:白内障术后角膜内皮失代偿27只眼(57.4％)、Fuch角膜内皮营养不良伴有白内障7只眼(14.9％)、玻璃体切除术后3只眼(6.4％)、虹膜角膜内皮(ICE)综合征3只眼(6.4％)、先天性青光眼3只眼(6.4％),角膜内皮植片失功的3只眼(6.4％)、陈旧性眼外伤球内异物1只眼(2.1％).手术方式:单纯行DSAEK 19只眼(40.4％);DSAEK联合白内障超声乳化和人工晶状体植入8只眼(17.0％);DSAEK联合前房人工晶状体取出+前段玻璃体切除和后房型人工晶状体悬吊术8只眼(17.0％);DSAEK联合前段玻璃体切除和后房型人工晶状体悬吊8只眼(17.0％);DSAEK联合单纯白内障摘除和前段玻璃体切除的为2只眼(4.3％);DSAEK失败改行穿透性角膜移植术2只眼(4.3％).结果术后47只眼中有10只眼发生植片脱位(21.3％),经再次前房注入气泡和黏弹剂后植片全部复位;术后有12只眼(25.5％)发生高眼压,其中有11只眼既往有青光眼的病史,另1只眼为ICE综合征患者,10例为一过性,药物控制后眼压稳定,2例行睫状体光凝手术(1例为前房人工晶状体眼、1例为ICE综合征患者).2例(4.3％)患者术后发生排斥反应,其中1例为前房晶状体的患者经治疗后逆转,另1例为Fuch角膜内皮营养不良的患者药物治疗无效更换植片.结论角膜内皮植片的脱位是角膜内皮移植术后最常见的并发症,前房注气是常用的复位方法;术后高眼压是第二位并发症,术前有否青光眼病史与术后高眼压密切相关.
목적 총결각막후탄력층박제자동판층도각막내피이식술(DSAEK)적병발증급처리방법.방법 회고성병례연구.대2007년9월지2009년2월재북경대학제삼의원안과중심접수DSAEK적42례환자(47지안)진행총결.인기각막내피실대상적원인:백내장술후각막내피실대상27지안(57.4％)、Fuch각막내피영양불량반유백내장7지안(14.9％)、파리체절제술후3지안(6.4％)、홍막각막내피(ICE)종합정3지안(6.4％)、선천성청광안3지안(6.4％),각막내피식편실공적3지안(6.4％)、진구성안외상구내이물1지안(2.1％).수술방식:단순행DSAEK 19지안(40.4％);DSAEK연합백내장초성유화화인공정상체식입8지안(17.0％);DSAEK연합전방인공정상체취출+전단파리체절제화후방형인공정상체현조술8지안(17.0％);DSAEK연합전단파리체절제화후방형인공정상체현조8지안(17.0％);DSAEK연합단순백내장적제화전단파리체절제적위2지안(4.3％);DSAEK실패개행천투성각막이식술2지안(4.3％).결과 술후47지안중유10지안발생식편탈위(21.3％),경재차전방주입기포화점탄제후식편전부복위;술후유12지안(25.5％)발생고안압,기중유11지안기왕유청광안적병사,령1지안위ICE종합정환자,10례위일과성,약물공제후안압은정,2례행첩상체광응수술(1례위전방인공정상체안、1례위ICE종합정환자).2례(4.3％)환자술후발생배척반응,기중1례위전방정상체적환자경치료후역전,령1례위Fuch각막내피영양불량적환자약물치료무효경환식편.결론 각막내피식편적탈위시각막내피이식술후최상견적병발증,전방주기시상용적복위방법;술후고안압시제이위병발증,술전유부청광안병사여술후고안압밀절상관.
Objective To summarize intra and post operation complications and their treatment of Descemet's Stripping Automated Endothelium Keratoplasty (DSAEK),and provide our experience for its development in China.Methods Retrospective case study.Forty-seven eyes of 42 patients underwent DSAEK performed by one surgeon.Indications include:Pseudophakic or aphakic Bullous Keratopathy,27 eyes (57.4％); Fuchs Endothelial Dystrophy,7 eyes (14.9％); endothelial decompensation post vitrectomy,3 eyes (6.4％) ; iridocomeal endothelial syndrome (ICE),3 eyes (6.4％) ; congenital glaucoma,3 eyes (6.4％) ; graft failure post endothelial keratoplasty,3 eyes (6.4％) ; endothelial decompensation after open ocular injury and intraocular foreign body,1 eye (2.1％).Nineteen eyes underwent single DSAEK (40.4％) ; eight combined phacoemulsification and intraocular lens implantation (17.0％) ; eight combined anterior chamber IOL (AC-IOL) removal plus anterior segment vitrectomy and posterior chamber IOL (PC-IOL) implantation (17.0％) ; eight combined anterior segment vitrectomy and PC-IOL suspension (17.0％) ; two combined cataract extraction and anterior segment vitrectomy (4.3％) ;two failed in DSAEK and underwent penetrating keratoplasty (4.3％).Results Dislocation is the most common postoperative complications.Ten eyes underwent dislocation in 47 eyes (21.3％),which was solved by air and viscoelastic agent injection.High intraocular pressure happened in 12 eyes (25.5％),in 11 of which had a history of glaucoma and 1 with ICE.After drug treatment,ten patients had stable intraocular pressure and two patients underwent ciliary body photocoagulation surgery (1 case with anterior chamber intraocular lens,1 case with ICE).Reactions happened in 2 cases (4.3％) patients,including 1 case with anterior chamber IOL (AC-IOL) rehabilitating after drug treatment and the other with Fuch's corneal endothelial dysfunction being regrafted.Conclusion Dislocation is the most common complication after corneal endothelial keratoplasty,and air injection in anterior chamber is a common and effective method ; High intraocular pressure is the second postoperative complication.Preoperative history of glaucoma is closely related to postoperative high intraocular pressure.