微型角膜刀辅助的板层角膜移植术治疗光治疗性角膜切削术后复发性颗粒状角膜营养不良

目的探讨微型角膜刀辅助的板层角膜移植术治疗光治疗性角膜切削术后复发性颗粒状角膜营养不良的疗效及安全性。方法选择光治疗性角膜切削术后复发性颗粒状角膜营养不良患者7人(9只眼)。用微型角膜刀分别在供体及受体上制作一定厚度的角膜植片及植床,把供体植片对位覆盖于受体植床上,间断缝合4~8针,术后4~6周拆除缝线。术前及术后的不同时间检查视力、角膜透明度、角膜厚度及角膜地形图。结果在平均(18.9±4.1)个月的随访期内,所有植片没有明显的混浊及严重并发症。患者术后视力均有不同程度的提高,其中7只眼最佳矫正视力大于或等于0.5,2只眼视力达到0.8,12个月后,角膜的屈光力平均增加(2.34±0.93)D(P<0.01),散光平均减小(0.91±0.98)D(P<0.05),术前角膜平均厚度(477.4±26.9)μm,至随访结束时角膜的平均厚度为(507.8±23.4)μm(P<0.01)。结论微型角膜刀辅助的板层角膜移植术治疗光治疗性角膜切削术后复发性颗粒状角膜营养不良是安全、有效的治疗方法。(中华眼科杂志,2005,41:1000-1004)     

全板层角膜移植联合深板层角膜内皮移植术治疗全角膜病变的初步临床观察

目的 探讨用微型角膜刀行全板层角膜移植联合深板层角膜内皮移植治疗全角膜损伤的适应证、手术原则、临床疗效及并发症的预防和处理.方法 系列病例研究.收集2005年5月至2006年3月在中山大学中山眼科中心住院患者的临床资料.应用微型角膜刀对11例患者的11只全角膜病损眼实施全板层角膜移植联合深板层角膜内皮移植术治疗,并对患者的术后矫正视力、眼压、中央角膜厚度及角膜内皮细胞密度进行随访观察12～18个月.结果 术后3、6及12个月随访检查,11只术眼视力均有提高,针孔矫正视力平均分别为4.4±0.3、4.5±0.3及4.5±0.3;术后1周内术眼的眼压短暂升高,但可用药物控制或缓解,术后3、6及12个月时随访检查术眼的眼压分别平均为(19.8±2.7)、(19.2±1.7)及(19.5±2.0)mm Hg;术后3、6及12个月时随访检查的角膜中央厚度分别平均为(538.9±8.9)、(536.3±6.3)及(537.2±6.9)μn;角膜内皮细胞密度在术后3、6及12个月时分别平均为(2519.8±110.7)、(2244.4±137.9)及(2093.3±141.9)个/mm2.术后主要并发症为两层植片间的间隙,此间隙可于术后1个月内自行消失.结论 采用微型角膜刀进行全板层角膜移植联合深板层角膜内皮移植术,可以提高患者视力,并较好地避免术后难治性青光眼的发生,是治疗全角膜损伤的有效术式.     

LASIK术中微型角膜板层刀对角膜厚度的影响

目的　比较 L ASIK手术前后角膜厚度的变化 ,分析微型角膜板层刀对角膜厚度的影响。方法　 48例(96只眼 )的角膜厚度在 L ASIK术前及术后不同时期进行测量 ,比较术后理论值与实测值的差异 ,分析理论值与实测值的差异所在 ,从而判断微型角膜板层刀是否对角膜厚度产生一定的影响。结果　术后 3天、7天的角膜厚度实测值与理论值有显著性差异 (P <0 .0 5 ) ,术后 1月实测值与理论值差异无显著性 (P >0 .0 5 )。结论　 L ASIK术中微型角膜板层刀的切割作用对角膜厚度会产生一定的影响。     

国产微型角膜刀在板层角膜移植术中的应用

板层角膜移植是治疗角膜疾病的一个重要手段。近年来 ,随着穿透性角膜移植成功率的提高 ,传统的板层角膜移植在临床上的使用有所减少 ,但是板层角膜移植有其自身的优点 ,在国内板层角膜移植仍占角膜移植的 1/ 3左右 [1 ,2 ] 。我们应用国产微型角膜刀进行了 6只兔眼和 2只人眼的板层角膜移植 ,植床植片创面光滑平整 ,使界面瘢痕减少到最低限度 ,且无需缝合 ,减少了术后散光 ,手术时间更是明显缩短。现将初步应用结果报道如下。1　对象与方法1.1　对象　实验动物及检查 :3只健康成年白兔均由上海医科大学实验动物部提供。以角膜地形图仪检查…     

前部深板层角膜移植治疗偏中心角膜溃疡穿孔效果评估

目的探讨偏中心角膜溃疡发生穿孔的患者采用前部深板层角膜移植（DLKP）治疗的有效性及可行性。方法回顾性病例研究。总结观察2008年12月至2011年1月间,11例（11眼）多种原因导致的角膜溃疡穿孔、穿孔范围1．5～2．0mm且穿孔部位在瞳孔边缘到角膜缘之间的患者行深板层角膜移植术,其中2例是独眼。术后对角膜移植片透明率、视力、眼压、角膜内皮细胞数量、排斥反应、角膜新生血管以及溃疡复发等进行评估。结果随诊观察12～24个月,平均（17．5±3．7）个月。10眼角膜移植术后愈合良好（91％）,无双前房形成,角膜移植片除穿孔区混浊外余均透明,恢复正常角膜厚度;1眼下方角膜溃疡者（患有类风湿和药物过敏）术后在溃疡处出现双前房,愈合不良导致植片混浊（9％）。所有患者视力均有提高,术前视力：光感：3眼,手动：5眼,指数：2眼,0．01～0．05：1眼;术后视力：0．01～0．05：1眼,0．1～0．2：8眼,〉0．2：2眼。眼压正常。角膜内皮数为1862～2756个／mm^2,平均（2286±293）个／mm^2。未发生排斥反应,角膜溃疡无复发,未发生角膜移植片和层间新生血管化。结论深板层角膜移植是治疗偏中心小范围角膜溃疡发生穿孔患者的有效方法。     

自动角膜板层刀切割一个供体角膜用于两位患者

目的评估应用自动角膜板层刀切割一个供体角膜用于深板层角膜移植和角膜内皮移植的临床疗效及安全性。方法回顾性系列病例研究。应用自动角膜板层刀预先将新鲜供体角膜进行切割,将带部分基质的角膜内皮植片用于角膜内皮移植术,剩余前板层用于深板层角膜移植术。回顾性分析2010年3—8月期间在温州医学院附属眼视光医院行角膜内皮移植术的17例患者及分别来自同一供体角膜的行深板层角膜移植的17例患者。术后随访19～24个月,分别观察角膜内皮贴附情况及前板层角膜植片愈合情况。随访资料包括医学验光、前节光学相干断层扫描及角膜内皮细胞计数。手术前后视力比较采用配对t检验。结果17例角膜内皮移植患者术后角膜内皮植片均贴附良好,术后视力较术前均有提高。除1例碱烧伤患者因晶状体混浊,无法验光外,其余术后平均散光为（1．69±0．60）D。17例角膜内皮移植患者平均角膜内皮细胞计数为（2128±244）个／mm^2,平均角膜内皮植片厚度为（152±46）μm。17例前板层角膜移植患者角膜植片均透明,术后最佳矫正视力较术前提高,平均散光为（2．50±0．90）D;平均前板层角膜植片厚度为（343±39）μm。结论利用角膜板层刀将一个供体角膜用于两位患者的方法在临床实际应用中切实可行。经长期随访,角膜植片未出现明显并发症。该方法可以更充分地利用供体角膜,缓解中国供体角膜匮乏现状,意义重大。     

眼球爆炸伤的板层角膜移植治疗

探讨板层角膜移植治疗眼球爆炸伤的临床效果。方法 :对 2 0例 ( 2 0只眼 )眼球爆炸伤的病例施行板层角膜移植治疗。其适应症为异物及混浊斑块主要在角膜组织的中浅层、深层基本透明或深层混浊斑块不处在角膜中央的病例。结果 :2 0例病人术后全部眼部刺激症状缓解 ,18例植片透明 ,17例视力有不同程度的提高。结论 :板层角膜移植是治疗眼球爆炸伤的有效方法 ,适用于爆炸伤所致的角膜中浅层异物及斑块状混浊。     

自体角膜缘干细胞移植术治疗角膜皮样瘤的研究

目的 探讨自体角膜缘干细胞移植治疗较小角膜皮样瘤的可行性.方法 前瞻性研究.将34例角膜皮样瘤患者按完全随机对照方法分成A组(肿瘤切除联合自体角膜缘干细胞移植术);B组(肿瘤切除联合异体板层角膜移植术).观察患者术后经过、肿瘤复发、以及视力、屈光度、散光度等情况.结果 A、B两组术后均未出现肿瘤复发,治愈率100％.A、B两组术后早期均有不同程度的角膜上皮糜烂,1月后角膜上皮基本愈合.A组2年后遗留不同程度的角膜翳,但未见新生血管进入角膜;B组术后外观改善良好,13例患者移植片透明.术后早期2例患者出现轻度层间混浊,新生血管到达角膜缘,3例患者出现层间新生血管,这5只眼治疗后,移植片透明.A、B两组术后裸眼视力、最佳矫正视力、屈光度、散光度差异无统计学意义(P＞0.05).结论 肿瘤切除联合自体角膜缘干细胞移植术对较小的角膜皮样瘤的疗效等同于异体板层角膜移植术,且该术式取材方便,手术简单,是一种安全可行的治疗方法.     

微型角膜刀联合纤维蛋白黏合剂行无缝线光学板层角膜移植术的实验研究

目的 探讨微型角膜刀联合纤维蛋白黏合剂行无缝线光学板层角膜移植术的可行性和安全性。方法 24只健康纯种新西兰白兔随机均分为两组,用微型角膜刀制作植片和植床,Ⅰ组应用市售纤维蛋白生物黏合剂Tisseel,Ⅱ组不用纤维蛋白生物黏合剂。术后3d、2周、1个月、3个月裂隙灯显微镜观察角膜透明度和排斥反应情况,自动验光角膜曲率仪检测角膜屈光状态的改变,共焦显微镜活体观察术后角膜的创伤愈合反应。同期取角膜标本进行常规苏木素-伊红(HE)观察,并用荧光显微镜观察层间新生胶原纤维的情况。结果 Tisseel组11只眼(92％)的植片在位,未用纤维蛋白生物黏合剂组所有植片均脱落。Tisseel组术后1个月角膜完全透明;共焦显微镜发现术后植片植床层间附近的基质细胞数量减少,而后基质细胞、内皮细胞数量和形态均无变化。HE染色显示,术后3d层间出现无固定形态的嗜曙红染色带,1个月时消失,荧光显微镜观察DTAF组织染色未见术后明显新生胶原纤维。结论 微型角膜刀联合纤维蛋白黏合剂行无缝线光学板层角膜移植术简便、安全,术后角膜的创伤愈合反应轻微,纤维蛋白黏合剂不影响角膜的光学性能。     

两种微型角膜刀在LASIK手术中的应用

目的　比较气动往复式和电动旋转式微型角膜刀在 L ASIK手术中的应用效果。观察两种角膜刀的应用特点 ,对术后视力、屈光度、角膜地形图的影响。方法　使用气动往复式和电动旋转式微型角膜刀行 L ASIK手术共 330例 (6 34只眼 ) ,其中往复刀切削组 93例 (184只眼 ) ,旋转切削组 2 37例 (4 5 0只眼 )。根据屈光度将两组患者分为 (- 6 .0 0 D以下 )和 组 (- 6 .0 0 D～ - 10 .0 0 D)。对术后 1天、10天、1月、3月复诊的裂隙灯、验光、角膜地形图记录资料作回顾性分析。结果　旋转微型角膜刀自动化程度高 ,性能稳定 ,做出的角膜瓣质量高。 SCMD微型角膜刀控制因素较多 ,熟练操作和经验积累过程较长 ,但调节灵活 ,适应于不同情况的患者。两组患者在术前屈光度、矫正视力上无明显差别 (P >0 .0 5 )。 Hansatom e组比 SCMD组在术后 1天、10天、1月、3月患者的视力、矫正视力、残存球镜、散光、角膜地形图散光上更为满意 ,统计结果显示明显的差异性。结论　两种微型角膜刀均可制作良好的角膜瓣。旋切刀可以提供术后更好的视力和平滑的角膜瓣 ,往复刀出现术后角膜散光和角膜瓣的微纹 ,术后3月两种术式患者屈光状态基本保持一致     

Quality of vision and graft thickness in deep anterior lamellar and penetrating corneal allografts

PURPOSE: To compare visual function after deep anterior lamellar keratoplasty (DALK) with visual function after penetrating keratoplasty (PK) for keratoconus and correlate this with corneal thickness. DESIGN: Retrospective case series. METHODS: Twenty-three patients (32 eyes) with unilateral or bilateral DALK or PK for keratoconus were analyzed for visual quality after suture removal. Evaluation included measurement of visual acuity, contrast sensitivity, and higher order aberrations (HOAs) (WaveScan; Visx, Santa Clara, California, USA). Readings were performed with both spectacle and rigid contact lens correction of refractive error. Total and residual stromal thickness after DALK was measured using optical coherence tomography (OCT) and correlated to visual quality. RESULTS: Eyes after PK had better visual acuity than eyes after DALK (P = .018). Subgroup analysis of DALK eyes revealed that the level of visual acuity was related to the thickness of residual recipient corneal stroma. Eyes with a recipient corneal bed thickness of <20 microm had visual acuities similar to eyes with a PK, whereas those with a recipient thickness of >80 microm had a significantly reduced visual acuity (P = .0009). Contrast sensitivity was similar in DALK and PK eyes. There was no significant difference in HOAs between eyes with DALK or PK. CONCLUSIONS: These data suggest that the main parameter for good visual function after DALK for keratoconus is the thickness of residual recipient stromal bed. An eye with a DALK with a residual bed of <20 microm can achieve a similar visual result as a PK.     

不同受者同期分别接受同者的角膜移植五例

目的 为提高角膜材料的利用率,探讨将同一噶供者的二个角膜同期移植给不同受者的可行性及手术方法.方法 供者的其中一个角膜材料分别为1例角结膜恶性黑色素瘤,1例蚕蚀性角膜溃疡伴穿孔行前部分板层角膜移植术,并对1例大泡性角膜病变行深板层角膜内皮移植术.另一个角膜材料分别为眼烧伤后重度睑球粘连行全板层角膜移植和1例大泡性角膜病变行深板层角膜内皮移植术.结果 5例角膜病患者手术均获得成功,其中2例大泡性角膜病变患者术后1个月,角膜上皮水泡消失,角膜水肿减轻,内皮植片透明.1例角结膜恶性黑色素瘤患者,视力术前0.3提高至术后0.6,植片透明,角膜植床及结膜无色素残留.1例蚕蚀性角膜伴穿孔经羊膜移植联合部分板层角膜移植治愈.1例眼烧伤睑球粘连患者,术后1个月,睑球粘连完全解除,植片透明,视力由术前0.1提高到0.3.结论 将同一供者的角膜分别移植给不同受者,能充分利用供者角膜材料,方法可行,效果良好.     

飞秒激光辅助的全板层角膜移植术治疗周边角膜病变

目的:探讨飞秒激光板层切削联合全板层角膜移植术治疗周边角膜病变的手术方法及治疗效果。方法:回顾性队列研究。收集2014年3月至2017年3月在青岛眼科医院因周边角膜病变行飞秒激光板层切削联合带角膜缘的全板层角膜移植术的6例（6只眼）患者作为飞秒组,其中男性4例,女性2例;年龄（46.7±17.9）岁;另收集同时期行传统...     

Endothelial keratoplasty using donor tissue not suitable for full-thickness penetrating keratoplasty

PURPOSE: To evaluate the use of corneal donor tissue deemed unsuitable for full-thickness penetrating keratoplasty (PK) for use in deep lamellar endothelial keratoplasty (DLEK) and to compare postoperative results to those of DLEK surgery using donor tissue that is suitable for PK. METHODS: Small-incision DLEK surgery was performed using 39 donor corneas unsuitable for PK. Thirty-five donors had anterior scars or opacities, 3 donors had pterygia within the 8-mm zone, and 1 had prior LASIK. All donor preparation was completed by manual stromal dissection. The DLEK surgical and postoperative courses were reviewed. Preoperative and 6-month postoperative results of this study group were compared with a control group consisting of the first 55 consecutive small-incision DLEK patients receiving donor corneas that had no criteria excluding them from use in PK. Four eyes in the study group and 1 eye in the control group had the confounding variables of the presence of an anterior-chamber lens or surgical vitrectomy with macular disease in the recipient eye. RESULTS: There was no significant difference in preoperative measurements of best spectacle-corrected visual acuity (BSCVA; P = 0.372), donor endothelial cell density (ECD; P = 0.749), or corneal topography [surface regularity index (SRI), P = 0.485; or surface asymmetry index (SAI), P = 0.154] between the 2 groups. For the patients receiving corneas deemed unacceptable for PK, at 6 months after surgery, the vision (P = 0.002) and corneal topography measurements improved significantly from before surgery (SRI, P < 0.001; SAI, P < 0.001), and there was no significant change in refractive astigmatism (P = 0.240). There was a significant difference in the vision at 6 months postoperatively between the overall study group and the control group, with the mean vision of the study group at 20/56 and the control group at 20/43 (P = 0.015). If eyes with known cystoid macular edema (CME) and vitrectomy are removed from each group, there is no significant difference in vision at 6 months between the study group and the control group (P = 0.110), with the average BSCVA of those receiving donor corneas unsuitable for PK equal to 20/48 (range, 20/25-20/200) and the average vision for those receiving PK-acceptable donor tissue equal to 20/43 (range, 20/20-20/80). The 6-month average refractive astigmatism of the study group was 1.12 +/- 0.99 D (range, 0.00-4.00 D), and the average endothelial cell count was 2064 +/- 396 cells/mm(2) (range, 1208-2957 cells/mm(2)). There was no significant difference in 6-month postoperative endothelial cell count (P = 0.443), refractive astigmatism (P = 0.567), or corneal topography (SRI, P = 0.332; SAI, P = 0.110) in study patients who received corneas unsuitable for PK compared with control patients who received corneas suitable for PK. CONCLUSIONS: Endothelial keratoplasty such as DLEK surgery with manual donor preparation broadens the donor pool by enabling corneas that cannot be used for PK to be used for selective endothelial transplantation without deleterious postoperative results.     

角膜移植治疗Terrien边缘角膜变性

目的 探讨角膜移植治疗Terrien边缘角膜变性的临床效果与安全性.方法 采用非随机回顾性系列病例研究.分析1995年1月至2004年12月期间在中山大学中山眼科中心行病灶切除联合角膜移植手术治疗的40例(48只眼)Terrien边缘角膜变性患者的临床资料,对其中9只眼进行手术前后的散瞳检影验光检查,对7只眼进行手术前后Orbscan Ⅱ角膜地形图检查.结果 患者年龄(30±6)岁,术后随访时间为(7±6)年.手术前、后各参数采用(Q25,Q75)表示.患眼手术前裸眼视力为(0.05,0.4),最佳矫正视力为(0.1,0.5),手术后裸眼视力为(0.2,0.6),最佳矫正视力为(0.4,0.7)(z=4.63,3.85;P均＜0.01).患眼验光球镜度数的术前值为(-2.00 D,-8.50 D),术后值为(-1.25 D,-4.75 D)(Z=2.49,P=0.01);柱镜度数的术前值为(2.50 D,12.00 D),术后值为(0.75 D,4.25 D)(Z=2.54,P=0.01).术后Orbscan Ⅱ角膜地形图模拟角膜曲率、角膜散光度数、角膜直径3 mm与5 mm处的散光度数和屈光力度数均较术前有所下降,除角膜直径5 mm处的散光度数改善外(Z=1.86,P=0.06),其余指标的改善差异均有统计学意义(P＜0.05).手术并发症包括术中植床穿孔5只眼(10.4%)、术后角膜层间积液8只眼(16.7%)、角膜层间上皮植入4只眼(8.3%)、脉络膜脱离1只眼(2.1%)、术后植片排斥反应7只眼(14.6%)、复发3只眼(6.3%).5只眼(10.4%)分别因层间积液、层间上皮植入及复发行二次手术治疗.结论 病灶切除联合角膜移植是Terrien边缘角膜变性的优选治疗手段之一,可有效地保存或提高患眼视力.     

Lamellar keratoplasty with air or viscoelastic substance injection

PURPOSE: To analyze the results of very deep lamellar keratoplasty using dissection with air and a viscoelastic substance. METHODS: This was a prospective monocentric noncomparative study. Candidates for lamellar keratoplasty were enrolled between November 1998 and July 2000. Deep lamellar dissection was performed following air injection into the cornea to create a white emphysema of the stroma. The dissection was performed to the Descemet membrane. Whenever a large bulla was present in the recipient bed, the dissection of the deepest stromal lamellae was performed by injecting a viscoelastic substance into the bulla. A full-thickness allogenic corneal button was sutured to the recipient bed. RESULTS: Fifteen eyes of 14 patients (mean age, 39.3 years) underwent deep lamellar keratoplasty: keratoconus (11 eyes), atopic keratoconjunctivitis (1 eye), herpes zoster keratitis (1 eye), corneal scar after pterygium surgery (1 eye), and rosacea keratitis (1 eye). Excluded from the analysis of the refractive outcome were patients who underwent intraoperative perforation (n = 3) and the patients with postoperative complications affecting the central visual axis: (n = 2 [hemorrhage in the interface and herpetic simplex keratitis]). The mean preoperative visual acuity was 0.10 (range, 0.05 to 0.3). After a 3.8-month-follow-up, the mean best corrected visual acuity was 0.21 (range, 0.1 to 0.6). The visual results were better in patients with keratoconus (mean best corrected visual acuity: 0.22; range, 0.1 to 0.6). The mean postoperative astigmatism was 4.15 diopters (range, 0 to 8). CONCLUSION: Intrastromal air and viscoelastic substance injection appeared to be very useful for performing a very deep lamellar keratoplasty. The results of the refractive outcome were encouraging. Deep lamellar keratoplasty is an interesting alternative to penetrating keratoplasty, because it cannot induce progressive primary graft failure and allogenic endothelial graft rejection and it obviates the need to perform a lamellar dissection of the donor button.     

Automated lamellar keratoplasty for recurrent granular corneal dystrophy after phototherapeutic keratectomy

PURPOSE: To evaluate the safety and efficacy of automated lamellar keratoplasty for the treatment of recurrent granular corneal dystrophy after phototherapeutic keratectomy (PTK). METHODS: We performed a prospective interventional noncomparative case study of nine eyes (seven patients) with severe recurrent granular corneal dystrophy after PTK. An automated microkeratome was used to cut partial-thickness sections through the anterior surface of the donor and host corneas. The donor disc was placed on the recipient bed with four or eight interrupted sutures. The sutures were removed between 4 and 6 weeks postoperatively. Visual acuity, corneal clarity, corneal thickness, and corneal topography were assessed before and at different time points after surgery. RESULTS: During a mean follow-up period of 18.9 +/- 4.1 months, all grafts were transparent without visible opacity at the interface, and no serious complications occurred. In all cases, the visual acuity improved: seven eyes had best spectacle-corrected visual acuity of > or = 20/40; two eyes reached 20/25. At last follow-up > 12 months postoperatively, the mean corneal refractive power had significantly increased by 2.34 +/- 0.93 diopters (D) (P<.001), and the corneal astigmatism significantly decreased by 0.91 +/- 0.98 D (P<.05). The mean corneal thickness was 477.4 +/- 26.9 microm preoperatively and 507.8 +/- 23.4 microm at last follow-up (P<.001). CONCLUSIONS: Our findings suggest that automated lamellar keratoplasty for the treatment of recurrent granular corneal dystrophy is a safe and effective method of improving visual acuity, but recurrence remains a risk.     

Conductive keratoplasty for the correction of residual hyperopia after LASIK

PURPOSE: To report the 6-month results concerning efficacy, safety, predictability, and stability of conductive keratoplasty for the correction of residual hyperopia after corneal refractive surgery. METHODS: A total of 35 eyes (26 patients) with residual hyperopia after corneal refractive surgery ranging between +1.00 to +4.75 diopters (D) of spherical equivalent refraction were enrolled in the study and underwent conductive keratoplasty following a modified nomogram. RESULTS: Variables and data were available for all eyes at 6 months postoperatively. A total of 24 (69%) eyes had uncorrected visual acuity (UCVA) of > or = 20/40, and 10 (29%) eyes had UCVA of 20/20. Manifest refractive spherical equivalent was within +/- 0.50 D in 17 (49%) eyes and within +/- 1.00 D in 25 (71%) eyes in cases of previous hyperopic LASIK; the optical zone was significantly increased. CONCLUSIONS: Using a modified nomogram, conductive keratoplasty for correction of residual hyperopia was effective, but predictability was not satisfactory and safety needs to be established.     

不剥除后弹力层的角膜内皮移植术治疗虹膜角膜内皮综合征的角膜失代偿

目的 探讨不剥除后弹力层的角膜内皮移植术治疗虹膜角膜内皮综合征的角膜失代偿的可行性和临床疗效.方法 回顾性非对照性系列病例研究.选择2008年1月至2009年12月在厦门大学附属厦门眼科中心住院的虹膜角膜内皮综合征的角膜失代偿7例患者,进行不剥除后弹力层的角膜内皮移植术.术后随访3～12个月,应用裂隙灯显微镜、前节相干光断层成像术、超声活体显微镜和激光共焦角膜显微镜观察植片透明度及植片贴附和植片移位等情况,应用角膜内皮细胞分析仪测量角膜内皮细胞密度,并对比手术前后的视力.结果 术后无1例免疫排斥反应、植片移位及晶状体损伤发生.3例患者术后第2天出现继发性青光眼,给予20%甘露醇静脉滴注,3例术后第3天随前房空气的逐渐吸收而眼压下降.1例术后高眼压控制不佳,在术后2周行睫状体光凝术后眼压控制正常.7例患者植片均透明,激光共焦角膜显微镜显示术后供受体界面、供体角膜基质的高反光性随着时间明显下降,前节光学相干断层成像术及超声生物显微镜显示角膜内皮植片与受体内皮面贴附良好且虹膜及角膜内皮粘连分离.6例患者术后最佳矫正视力均有不同程度的提高;1例患者术后视力不提高的原因为青光眼性视神经萎缩.术后平均角膜内皮细胞密度为(2176.6±267.6)个/mm2.结论 不剥除后弹力层的角膜内皮移植术治疗虹膜角膜内皮综合征的角膜失代偿具有安全、有效、操作简便等特点,有望成为治疗该病的手术方式之一.

Abstract：

Objective To investigate the feasibility and clinical effects of non-Descemet stripping endothelial keratoplasty ( nDSEK) on treating iridocomeal endothelial (ICE) syndrome in phakic eyes. Methods Retrospective noncomparative interventional case series. 7 patients (7 eyes) with ICE syndrome at the Affiliated Xiamen Eye Center of Xiamen University from January 2008 to December 2009 underwent non-Descemet stripping endothelial keratoplasty. All patients were followed up for 3-12 months, pre- and postoperative best corrected visual acuity ( BCVA) were compared, the adherence of the donor disc to the recipient endothelium and postoperative donor disc dislocation were monitored during the follow-up period. Graft clearance and endothelial cell density(ECD) were observed, too. Results After nDSEK, no primary graft failures dislocation and decentered graft occurred during the follow-up period. Study group intraoperative complications included 3 case with elevated intraocular pressure 2 day postoperatively. Subepithelial haze, donor-recipient interface haze, and interface particles were observed in all measurable cases by in vivo laser confocal microscopy. Anteriorsegment optical coherence tomography and ultrasound biomicroscopy showed the adherence of the donor disc to the recipient endothelium and peripheral anterior synechiae were separated. All corneas remained clear during the follow-up. 6 patients had improved BCVA while 1 patient had the same BCVA. The reason for poor VA was optic atrophy due to glaucoma. Postoperative mean EDC was (2176. 6 ± 267. 6) cells/mm2. Conclusions nDSEK for iridocorneal endothelial (ICE) syndrome is feasible, technically easy, safe and effective. It can be one of the surgical treatment option for bullous keratopathy.