穿透性角膜移植术后角膜内皮细胞密度的改变

目的 :观察穿透性角膜移植术后植片角膜内皮细胞密度的变化。方法 :用角膜内皮显微镜对术前供体角膜及术后一年内受体植片的内皮细胞密度进行连续观察。结果 :术后植片内皮细胞下降率为 :一周 0 2 2 % ;二周 3 94% ;三周 5 74% ;二月 8 68% ;三月 10 0 9% ;六月 14 68% ;一年 2 6 7%。结论 :穿透性角膜移植术后植片内皮细胞在前三周为快速下降期 ,第二个月至一年为慢速稳定下降期 ,将为临床医师在手术时对供体的选择、手术技巧及术后治疗提供参考。     

穿透性角膜移植的内皮细胞变异分析

目的 :探讨穿透性角膜移植的供眼角膜内皮细胞变异情况及影响其变异的因素。方法 :用角膜内皮显微镜对穿透性角膜移植 44只眼的供眼及术后移植片行内皮细胞摄相分析。并用超声角膜测厚仪测量供眼角膜及术后移植片厚度。结果 :术后 2～ 6周、 3～ 6月、 7～ 12月及 1 5～ 2年的内皮细胞丧失率分别为 12 98%、 2 2 2 3 %、 2 7 2 6%及 2 9 78%。平均细胞面积由术前的 44 5 13 μm2 增加到术后 1 5～ 2年的 65 4 42 μm2 ,细胞大小变异系数 (CV值 )由 43 2 4%增加到 64 76% ,六角形细胞比例由 45 2 6%下降到 2 7 18%。单纯穿透性移植组与穿透性移植联合手术组术后 1 5年～ 2年的细胞丧失率、平均细胞面积、CV值和六角形细胞比例均有显著性差异 (P <0 0 5 ) ,但移植片厚度无显著性差异 (P >0 0 5 )。结论 :穿透性角膜移植后供眼角膜内皮细胞密度逐渐减少 ,平均细胞面积和CV值均渐增大 ,六角形细胞比例渐变小。穿透性角膜移植联合手术比单纯穿透性移植的术后内皮细胞丧失率较高 ,平均细胞面积和CV值增大较显著 ,六角形细胞比例下降较大但移植片厚度无显著性差异。     

深板层与穿透性角膜移植术后角膜内皮细胞密度的比较研究

目的研究穿透性角膜移植术(Penetrating keratoplasty,PKP)和深板层角膜移植术(Deeplamellar keratoplasty,DLKP)术后不同时间角膜内皮细胞密度(Endothelial cell density,ECD)的变化情况,以明确这两种术式对移植术后角膜内皮细胞变化的影响。方法采用非接触角膜内皮显微镜(Specular microscopy)及细胞图像分析系统(I MAGEnet2000)连续采集分析17例穿透性角膜移植及13例板层角膜移植术角膜内皮细胞情况,观察术后患者1、3、6、12及24个月时的角膜内皮细胞变化情况。并对结果进行统计学分析。结果17例(眼)PKP术前供体的角膜内皮细胞平均密度为(3390.4±259.5)个/mm2,术后1个月为(3073.7±392.1)个/mm2,术后3个月为(2834.0±456.1)个/mm2,术后6个月为(2591.2±366.7)个/mm2,术后12个月为(2180.6±250.8)个/mm2,术后24个月为(1820.5±198.2)个/mm2。13例(眼)DLKP术前患者健眼的内皮细胞平均密度为(3442.7±178.7)个/mm2,术后1个月为(3224.3±315.4)个/mm2,术后3个月为(3062.2±277.2)个/mm2,术后6个月为(2978.3±287.3)个/mm2,术后12个月为(2968.3±312.9)个/mm2,术后24个月为(2888.5±296.7)个/mm2。结论深板层角膜移植内皮细胞丢失速率较穿透性角膜移植小,术后细胞存活数目较穿透性角膜移植多。     

穿透性角膜移植术中减少角膜内皮损伤的技术

探讨穿透性角膜移植术中减少角膜内皮损伤的方法。方法在２４例穿透性角膜移植手术中,采用多种保护角膜内皮的方法包括：剪取供体植片时前房注入１％透明质酸钠;内皮侧冲切植片;６针预置缝合后前房注入１％ＳＨ及ＢＳＳ以完全形成前房。     

角膜移植术后供体角膜内皮细胞的变化

目的用角膜内皮显微镜对穿透性角膜移植的供眼及术后移植片定期进行内皮细胞摄相观察，探讨供眼角膜内皮细胞的变异情况以及影响其变异的因素。方法选择做穿透性角膜移植的15例病人，用角膜内皮显微镜对术前供眼及术后植片进行定期内皮细胞密度、平均细胞面积、细胞大小变异系数(CV值)及细胞形态方面检查分析。结果(1)术后2～6周、3～6个月、7～11个月及1～1．5年的内皮细胞丧失率分别为12．17％、21．91％、26．55％及29．28％。(2)供眼角膜内皮细胞的平均细胞面积由术前的457．06μm^2逐渐增加到术后1～1．5年的646．34μm^2，CV值由52．42％增加到62．32％。(3)供眼六角形内皮细胞的比率由术前的41．76％下降到术后1～1．5年的28．08％。结论穿透性角膜移植术后供眼角膜内皮细胞密度逐渐减少，细胞丧失率逐渐增大，术后3～6个月增大最明显，7～11个月变化较小，趋于稳定。平均细胞面积及细胞大小变异系数均逐渐增大。标准的六角形细胞比例则逐渐变小，非六角形细胞的比例相应增大。穿透性角膜移植术后，植片均能透明愈合，且角膜厚度在正常范围内，并获得良好视力，因此其是使角膜病失明患者复明的重要手段。     

穿透性角膜移植术后的角膜地形图分析

计算机辅助角膜地形图仪的出现为精确分析精确分析角膜形态和曲率提供了可靠依据。本文选取３０例已行角膜移植术的病人进行临床回顾性研究，据角膜地表图提供的资料，结合不同术式，随访时间进行了统计分析。     

穿透性角膜移植术治疗大泡性角膜病变

目的 探讨穿透性角膜移植术治疗大泡性角膜病变的临床疗效。方法 对17例17眼大泡性角膜病变施行穿透性角膜移植术或穿透性角膜移植联合手术。随访观察2～43个月并进行了回顾性分析。结果 角膜植片透明12例,半透明3例,植片混浊2例。其中4例在术后2周～21个月发生角膜免疫排斥反应,经保守治疗后控制。全部患者术后眼部刺激症状消失。除1例术前视力无光感,术后视力无变化外,其余病例术后视力均有不同程度提高。结论 穿透性角膜移植术或穿透性角膜移植联合手术,是解除眼部疼痛刺激症状、提高视力的首选而有效的方法。     

穿透性角膜移植术后低密度角膜内皮细胞白内障手术的临床观察

目的探讨穿透性角膜移植术(PKP)后角膜植片低内皮细胞密度的白内障患者行白内障摘除联合人工晶状体植入术的安全性。方法 PKP术后角膜内皮细胞计数<1500个/mm2行白内障摘除联合人工晶状体植入术治疗的患者15例(15只眼),根据晶状体核硬度分别选择不同的手术方式,行相应的围手术期处理,分别记录术前及术后3个月患者裸眼视力、角膜内皮细胞计数及裂隙灯观察角膜植片情况。结果术前内皮细胞计数为(1195±315)个/mm2,术后3个月内皮细胞计数为(1044±301)个/mm2,差异有统计学意义(P=0),内皮损失率为12.6%。术前及术后3个月的裸眼视力分别为0.06±0.09和0.35±0.22,两者差异有统计学意义,平均提高>5行标准视力表。白内障术后6个月之内无一例角膜内皮功能失代偿及角膜植片免疫排斥反应,角膜植片均保持透明。结论 PKP术后角膜植片内皮细胞计数<1500个/mm2的患者,只要注意围手术期治疗,选择合适的手术方法,和注意术中保护角膜内皮细胞,白内障摘除联合人工晶状体植入术是安全有效的。     

Endothelial Cell Loss in Penetrating Keratoplasty

Quantitative specular endothelial microscopy was performed on 39 donor corneas before operation and at three and 12 months following penetrating keratoplasty. The central endothelial cell density of these corneas had decreased by 18.3% at three months after operation and by 33.6% at the end of one year. This decrease in cell density probably results both from cell death and from migration of cells toward the peripheral cornea. Postoperative cell counts were correlated closely with preoperative counts but not with donor age. Therefore, it is important to screen donor corneas before operation with the clinical specular microscope.     

椭圆形植片穿透性角膜移植术的初步临床应用

目的 :评价椭圆形植片穿透性角膜移植术的安全性和可靠性 ,并确立其临床适应症。方法 :所有穿透性角膜移植术的角膜白斑病例术前测微尺测量角膜白斑的长径与短径。选取水平径大于垂直径的大白斑病例做椭圆形植片穿透性角膜移植术 ,余者均行常规圆形穿透性角膜移植术。术后三月以上选择性拆线 ,并随访角膜地形图 ,植片透明的共 5 6例纳入本文分析。结果 :椭圆形植片与圆形植片愈后可矫正视力≥ 0 3 ,分别占 46 7%与 5 7 7% ,0 1～ 0 3分别占 40 0 %与 3 4 6% ,二者的脱残率 (大于等于 0 3 )统计学分析。P >0 0 5 ,无显著性差别。二者的SRI与SAI相比亦没有显著性差别。椭圆形植片术后平均散光度数为 4 60± 0 84D ,圆形植片术后平均散光度数为 5 15± 1 80D ,统计检验得P >0 6。所有病例中小于 3 0D散光共有 17例 ,大于 3 0D的垂直向屈光度增加 ,椭圆形植片有 19例 ,圆形植片有 16例 ;而水平向屈光度增加 ,则分别为 1例和 3例 ,经卡方检验P >0 0 5 ,二种形态的植片散光分布特征无显著统计学差异 ,且仍存在水平向角膜屈光力纠正不足。结论 :椭圆形穿透性角膜移植术具有较高的安全性和可行性。结合本文所定适应证和采用的术式 ,椭圆形植片术后的散光约在5 0D左右 ,一部分病例存在水平向屈光纠     

Reconstructive Keratoplasty in the Management of Conditions Leading to Corneal Destruction

Progressive corneal destruction of varying causes can result in pathologic changes that are incompatible with globe survival. Reconstructive keratoplasty and scleroplasty, in combination with other procedures, can be attempted as an alternative to enucleation, evisceration or spontaneous phthisis bulbi. The results of 50 reconstructive keratoplasties in 36 patients with severe corneal destruction are presented with one- to twenty-two year follow-up. Ninety-nine percent of the eyes were salvaged, 69% have clear grafts, 86% are visually improved and 51% achieved acuity of 20/100 or better.     

角膜移植联合抗青光眼术治疗角膜瘘（附22例病例分析）

应用角膜移植联合抗青光眼术治疗角膜瘘共22例（22只眼），术后效果较好，在穿透角膜移植的13例中，术后全部达到封瘘目的，11例术后植片透明，8例术后视力提高；板层角膜移植9例，术后也全部达到封瘘目的，并有4例植片透明，5例术后视力提高，手术主要合并症是持续性上皮缺损和虹膜前粘连，并就手术适应症、手术方式的选择及技术操作等方面进行了讨论。     

Penetrating Keratoplasty Following Thermokeratonlasty

We analyzed the long-term results of penetrating keratoplasty following thermokeratoplasty in 17 eyes, and these were compared with 44 eyes in which penetrating keratoplasty was the primary procedure. There was a greater incidence of graft rejection in the TKP group than in the non-TKP group although this difference was not statistically significant. A definite causative factor for this discrepancy could not be identified. Mild inflammatory reaction in TKP-treated corneas and the generally poorer prognosis in corneas needing TKP may be the causative factors for the greater number of failed grafts in the TKP group.     

Results of Therapeutic Penetrating Keratoplasty

Purpose By a retrospective study of patients in the Ankara Hospital Eye Clinic, to determine the anatomical and visual results of therapeutic penetrating keratoplasty (PK) and its role in the management of corneal disease.Methods Therapeutic PK was performed in 36 patients (37 eyes) who had corneal perforation due to corneal disease (23 eyes) or eyes in which perforation was imminent (14 eyes). Initial indications for grafting were nonperforated descemetocele without inflammation (six eyes, 16.2%); nonperforated bacterial corneal ulcer (five eyes, 13.5%); nonperforated herpetic keratitis with active stromal inflammation (two eyes, 5.4%); acanthamoeba keratitis (one eye, 2.7%); perforation due to herpetic keratitis (13 eyes, 35.2%); perforation due to persistent epithelial defect (8 eyes, 21.6%); or perforation due to bacterial corneal ulcer (two eyes; 5.4%). The results were evaluated for each of the following criteria: anatomical integrity of the eye, cure of the disease, complications, graft clarity, and visual acuity.Results Anatomical integrity was achieved in 21 of the 23 eyes (91.3%) perforated from corneal disease. Therapeutic PK cured the disease in all bacterial keratitis cases. The proportion of clear grafts was 60.9% in the 23 eyes perforated from corneal disease, and 57.1% in the 14 eyes in which perforation was imminent. Fifteen eyes (40.5%) obtained a final visual acuity of 20/100 or better; five of these eyes were not yet perforated before the PK.Conclusions Therapeutic PK is effective in the management of the eye with active uncontrolled infection or perforation from corneal disease. Approximately half of our patients maintained a clear graft at the last visit. Without therapeutic surgery, these eyes would have been lost. Jpn J Ophthalmol 2004;48:368–371 © Japanese Ophthalmological Society 2004     

An Analysis and Interpretation of Refractive Errors after Penetrating Keratoplasty

Despite advances in microsurgical techniques, astigmatism after penetrating keratoplasty is still a perplexing problem. In this paper, using retrospective studies, experiments, and observations, the factors that seem most significant in creating excessive postoperative astigmatism are delineated. The difficulty of creating a circular recipient hole of the same size and shape as the donor button appears to be a prime area for clinical research and technical development.     

Corneal Endothelial Transplantation

Patients with visually significant corneal edema, secondary to endothelial dysfunction, before the development of scarring or vascularization, need only have the corneal endothelium replaced to restore corneal clarity. This fact, plus the lack of consistently available donor material, prompted us to evaluate tissue cultured corneal endothelium (TCCE) as a donor source. We have shown that TCCE, when transplanted, can regain normal morphology and physiologic function. To accomplish practical use of autologous stroma, a transparent gelatin membrane which can serve as substrate for endothelial growth in tissue culture, has been developed. This cellular membrane has been transplanted successfully in rabbits with good functional results. It is hoped that ultimately this technique can be developed for routine use in man.     

Corneal oedema after cataract surgery: predisposing factors and corneal graft outcome

Purpose: Pseudophakic bullous keratopathy (PBK) is one of the main indications for corneal transplantation. Graft survival and visual outcome in this group are often poorer than for other indications. The aim of this study was to find risk factors for developing corneal oedema after cataract surgery and factors that influence the subsequent survival of the graft and the visual outcome. Methods: We carried out an observational, retrospective cohort study using data from the Swedish Cornea Transplant Register and patient medical records. A total of 273 patients whose indication for corneal transplantation was corneal oedema after cataract surgery were included in the study. Multiple logistic regression analysis and, where appropriate, univariate analyses were applied. Results: A total of 43% of the patients developed persistent corneal oedema immediately after cataract surgery, the main risk factors for which were phacoemulsification and pre‐existing endothelial disease. Almost a third (32%) of the transplants for PBK failed within 2 years, for which rejection and other postoperative complications increased the risk. Half (50%) the patients had visual acuity ≤ 0.1 at 2 years after keratoplasty. Comorbidity, increasing duration of the bullous keratopathy and increasing age affected the visual outcome negatively. Conclusions: Phacoemulsification was a risk factor for immediate persistent corneal oedema after cataract surgery, although it did not increase the overall risk of developing PBK. However, transplants for immediate PBK had a better survival rate than those for later onset PBK. Shorter duration of PBK and intraocular lens exchange at the time of penetrating keratoplasty increased the likelihood of good visual acuity.