角膜后弹力层剥除内皮移植术治疗大泡性角膜病变的初步疗效观察

摘要

目的 探讨角膜后弹力层剥除内皮移植手术的适应证、手术方法以及对大泡性角膜病变的疗效与并发症的处理.方法 非随机回顾性系列病例研究.选择2006年9月至2007年10月于中山大学中山眼科中心住院的8例(8只眼)大泡性角膜病变患者行角膜后弹力层剥除内皮移植术.术中剥除患眼角膜中央部直径7.75 mm的后弹力层和病变的内皮层,再将植床周边部基质表面刮粗糙,然后按常规角膜内皮移植术的方法植入内皮植片.术后观察植片与植床贴合和植片移位等情况.随访3～9个月,记录患者视力、植片透明度、角膜散光及内皮细胞密度.结果 8例患者术后植片与植床贴合良好,未出现植片移位.术后第1天,1例患者出现继发性闭角型青光眼,术后48 h后缓解.8例患者术后植片透明,术前存在眼痛的6例患者术后眼痛缓解.8例患者术后视力均提高,最好矫正视力为0.3～0.7,平均角膜散光度数为(1.90±0.70)D,平均内皮细胞密度为(2014±192)个/mm2.结论 与深板层角膜内皮移植术比较,角膜后弹力层剥除内皮移植术的操作较简单,对受体角膜和前房的创伤更小.术中将植床周边部基质表面刮粗糙,可有效预防术后植片移位.%Objective To investigate the indications, surgical procedure, clinical efficacy, and the prevention and management of complications of Descemet's stripping with endothelial keratoplasty (DSEK) for bullous keratopathy. Methods In the nourandomized retrospective consecutive case series, 8 patients (8 eyes) with bullous keratopathy at Zhongshan Ophthalmic Center between September 2006 and October 2007 underwent DSEK surgery. During the surgical procedure, the Descemet's membrane and abnormal endothelial layer were stripped from the central recipient posterior surface with 7.75 mm diameter, and then a specially designed scraper was used to roughen the peripheral recipient posterior stroma. Other surgical techniques were the same with routine DSEK surgery. The adherence of the donor lenticule to the recipient posterior stroma and postoperative donor lenticule dislocation were monitored in the early stage after surgery. Best spectacle-corrected visual acuity (BSCVA), graft clearance, corneal astigmatism and endothelial cell density (ECD) were observed over a 3-9 months follow-up period. Results All donor lenticules were well adherent to the recipient posterior stroma and no graft dislocation occurred postoperatively. One patient had papillary block glaucoma at 1-day, and relieved after 48 hours postoperative. All grafts remained transparent, and had improved visual acuity. BSCVA was 0.3-0.7 postoperative. Six patients with preoperative pain had been pain free after DSEK procedure. Mean corneal astigmatism was ( 1.90 ± 0. 70) diopter(D). Mean ECD was (2014 ± 192) cells/mm2. Conclusions Compared with deep lamellar endothelial keratoplasty ( DLEK), DSEK procedure is technically easier and less traumatic to recipient comes and anterior chamber structures. The skill of roughening the peripheral recipient posterior stroma should prevent postoperative graft dislocation effectively.