角膜深板层内皮移植的三年临床观察

目的:探讨用微型自动角膜板层刀进行深板层角膜内皮移植术(microkeratomeassociateddeeplamellarendothelialkeratoplasty,MDLEK)的临床效果和不良反应。方法:对于2002年1月～2002年3月期间,用MDLEK治疗的6例大泡性角膜病变患者进行随访观察。结果:术后3个月5例患者最佳校正视力较术前明显提高,最高者可达0.7,并在以后的随访中保持稳定;术后3个月患者平均散光为(2.04±1.19)D,以后进一步减退;角膜中央厚度于术后3个月已接近正常水平,此后无显著变化;术后角膜内皮密度逐步下降,其下降速率与穿透性角膜移植相仿;共焦显微镜观察发现术后1a,创面附近的角膜基质细胞已趋于正常,且角膜中央视轴区无明显瘢痕。随访期内未发现角膜深层缝线导致新生血管或引起排异反应。结论:MDLEK用以治疗角膜内皮失代偿安全、实用;术后恢复视力时间短;术后散光小;术后板层创面愈合快,光学性能满意。

A Three Years Follow-up Study on Microkeratome Associated Deep Lamellar Endothelial Keratoplasty

PURPOSE: To investigate the therapeutic effects and side effects of microkeratome associated deep lamellar endothelial keratoplasty (MDLEK). METHOD: Six patients with bulbous keratopathy who underwent MDLEK were follow up for three years. RESULTS: The best corrected visual acuity improved obviously in 5 cases within 3 months post operation and kept stable afterward during the follow up time. One of them even arrived 14/20. Meanwhile the Astigmatism averaged (2.04 +/- 1.19)D 3 months post operation and from then on decreased gradually. Pachymetry appeared almost normal and showed stabilization. Post-operative endothelial cells density decreased in a model similar to that in penetrating keratoplasty. Keratocytes were found to be normal by confocal microscope and there was no scar in the visual axial area 12 months post operation. The deep sutures caused no neovascularization and rejection. CONCLUSION: MDLEK is a safe and applied surgical therapy for bulbous keratopathy with shorter visual recovery time, lower astigmatism and approving optical property of post-operative corneal.