角膜后弹力层剥除联合自动角膜刀取材内皮移植术的临床研究

摘要

Objective To investigate the clinical efficacy, prevention and management complications and choice of indication with Descemet membrane stripping with automated endothelium keratoplasty (DSAEK).Methods Clinical case series.Nine patients (9 eyes) with bullous keratopathy underwent DSAEK procedure from Peking University Eye Center, Peking University Third Hospital during September to December in 2007.Visual acuity, cornea transparence, graft position, corneal thickness, curvature, astigmatism and endothelial cells density ( ECD) were observed over 3-7 month follow-up period.Results One patient with iris cornea endothelium syndrome was fail to insert graft into anterior chamber and changed procedure to penetrating keratoplasty.Eight patient successfully performed procedure.One graft dislocation in was managed in first day after surgery.All 8 grafts remained transparent and improved visual acuity.After surgery, mean corneal thickness was (775 ±30) μm Mean comeal curvature was (44.19 ± 2.28) D.Mean corneal astigmatism was (2.20 ±0.83) D.Mean endothelial cells density was (1439 ± 296) cells/mm~2.Conclusions DSAEK is a less damage, faster recovery vision, safer procedure.It is expected to be the important procedure to treat bullous keratopathy.%目的 探讨角膜后弹力层剥除联合自动角膜刀取材内皮移植术的术后疗效、并发症、处理及适应证的选择.方法 临床病例系列研究.2007年9至12月期间,北京大学第三医院、北京大学眼科中心选择9例角膜内皮失代偿的患者行角膜后弹力层剥除自动角膜刀取材及角膜内皮移植手术,术后观察视力、角膜透明性的恢复、植片的脱位率、角膜厚度、角膜曲率及角膜内皮细胞数,随访时间3～7个月.结果 手术中1例虹膜角膜内皮综合征患者的角膜内皮植片植入失败,改行穿透性角膜移植术;其余8例患者术后植片明显脱位1例,再处理后复位.术后8例手术成功患者视力全部提高,植片透明,角膜厚度为(775±30)μm;角膜曲率为(44.19±2.28)D;角膜散光度数为(2.20±0.83)D;角膜内皮细胞数为(1439±296)个/mm~2.结论 角膜后弹力层剥除联合自动角膜刀取材内皮移植术有可能成为一种治疗角膜内皮失代偿的重要术式.