不同病因对角膜内皮移植术后视力的影响

背景 角膜后弹力层剥除联合自动角膜刀取材内皮移植术（DSAEK）是目前治疗角膜内皮失代偿的首选术式,但不同角膜病变患者术后视力恢复情况国内外的报道有所不同. 目的 比较不同病因所致角膜内皮失代偿患者DSAEK术后视功能的恢复情况,评价不同角膜病变对DSAEK术后视力的影响. 方法 回顾性分析2007年12月至2009年12月在北京大学第三医院眼科就诊的角膜内皮失代偿患者67例71眼的临床资料,根据原发病因的不同将其分为Fuchs角膜内皮营养不良组19例22眼、白内障术后大泡性角膜病变组36例37眼及其他因素引起的角膜内皮失代偿者（其他病因组）12例12眼,所有患眼均行DSAEK,分析其术后第1、3、7、30、90、180天各组术眼视力改善情况,采用SPSS 16.0统计学软件的x2检验和重复测量两因素方差分析对各组术眼手术前后不同视力的眼数分布及不同病因组在不同时间点LogMAR视力的差异进行比较. 结果 入选的71眼中,71.83％的患眼术前视力低于0.1,所有患眼视力均低于0.3.术前Fuchs角膜内皮营养不良组、白内障术后大泡性角膜病变组和其他病因组总体比较视力差异无统计学意义（x2=3.427,P＞0.05）.术后第1 80天,Fuchs角膜内皮营养不良组视力≥0.8者5眼,占22.73％,略高于白内障术后大泡性角膜病变组的10.81％和其他病因组的8.33％,但3个组间不同视力的眼数分布差异无统计学意义（x2=0.330,P＞0.05）.3个组患眼随着术后时间的延长,LogMAR视力值逐渐下降,差异有统计学意义（F时间=88.000,P＜0.01）;术后第7天,白内障术后大泡性角膜病变组LogMAR视力值为1.29±177;0.57,明显高于Fuchs角膜内皮营养不良组的0.82±177;0.43和其他病因组的0.91±177;0.39,差异均有统计学意义（P＜0.05）;术后第90天,Fuchs角膜内皮营养不良组LogMAR视力值为0.40±177;0.28,明显低于白内障术后大泡性角膜病变组的0.64±177;0.44和其他病因组的0.73±177;0.54,差异均有统计学意义（P＜0.05）;而术后第180天,3个组间LogMAR视力值的差异均无统计学意义（P＞0.05）.Fuchs角膜内皮营养不良组视力在术后3个月时达稳定,白内障术后大泡性角膜病变组和其他病因组术后90～ 180 d视力仍有变化. 结论 DSAEK是治疗各种角膜内皮失代偿的有效方法,Fuchs角膜内皮营养不良、白内障术后大泡性角膜病变和其他病因引起的角膜病变行DSAEK术后6个月视力均恢复较好,但Fuchs角膜内皮营养不良患者术后视力恢复更快.

Influence of different corneal diseases on visual recovery following Descemet stripping automated endothelial keratoplasty

Background Descemet stripping automated endothelial keratoplasty （DSAEK） is the main treatment for corneal endothelial dysfunction.But the visual outcome after operation varies depending on the difference of corneal diseases.Objective This study was to evaluate and compare the visual outcomes following DSAEK in different keratopathy.Methods The clinical data of 72 eyes of 67 patients with endothelial dysfunction underwent DSAEK from December 2007 to December 2009 at Peking University Third Hospital were retrospectively analyzed.The patients were divided into Fuchs endothelial dystrophy （FED） group （22 eyes of 19 cases）,cataract surgeryinduced bullous keratopathy group （37 eyes of 36 eases） and other endothelial keratopathy group （12 eyes of 12 cases）.The distribution of visual acuity and LogMAR acuities were compared and evaluation among the 3 groups before operation and 1 day,3,7,30,90 and 180 days after operation.Results Preoperatively,the vision was lower than 0.1 in 71.83% patients,and all the patients had the visual acuity less than 0.3.No significant difference was found in the preoperative acuity among the FED group,cataract surgery-induced bullous keratopathy group and other endothelial keratopathy group（x2 =3.427,P〉0.05）.The visual acuity was ≥ 0.4 in 40 eyes （56.34%） and ≥ 0.1 in 65 eyes （91.55%）,and the percentage of vision ≥0.8 was 22.73% in the FED group,10.81% in the cataract surgery-induced bullous keratopathy group and 8.33% in the other endothelial keratopathy group,and no significant difference was found in the percentage of eyes in different visual acuities 180 days after operation （x2 =0.330,P〉 0.05）.In the 3 groups,LogMAR values were gradually decreased with the lapse of the time,showing a significant difference （Ftime =88.000,P 〈 0.01）.In the seventh day after operation,LogMAR value was 1.29 ±177; 0.57 in the cataract surgery-induced bullous keratopathy group,which was significantly higher than that of the FED group （0.82±177; 0.43） or other endothelial keratopathy group （0.91 ±177;0.39） （both at P〈0.05）.Ninety days after operation,LogMAR value was 0.40 ±177;0.28 in the FED group and was significantly declined in comparison with the cataract surgeryinduced bullous keratopathy group （0.64±177;0.44） and other endothelial keratopathy group （0.73±177;0.54） （both at P〈0.05）.However,no significant differences was seen in the LogMAR values among the three groups 180 days after operation （all at P〉0.05）.The vision was stable 3 months after operation in the FED group,however,the vision was still changed over 3 months in the cataract surgery-induced bullous keratopathy group and other endothelial keratopathy group.Conclusions DSAEK is available for corneal endothelial diseases.Visual acuity improves more rapid in FED patients than other keratopathies.