不剥除后弹力层的深板层角膜内皮移植术治疗大泡性角膜病变的初步临床观察

目的 探讨不剥除后弹力层的深板层角膜内皮移植术治疗大泡性角膜病变的可行性和临床疗效.方法 前瞻性系列病例研究,收集自2007年9月至2009年1月在我院住院的大泡性角膜病变患者,进行不剥除后弹力层的深板层角膜内皮移植术.术中均未处理患眼角膜内皮.直接用植入镊将制作好的直径为8.5mm的角膜内皮植片植入受体前房,气体顶压植片进行固定.术后随访6～20个月,观察植片贴附和植片移位等情况,对手术前后的视力进行比较,检查植片透明度和角膜内皮细胞密度.结果 5例患者术后植片与受体内皮面始终贴附良好;1例患者术后第2天出现层间裂隙,经改俯卧位后植片贴附良好.6例患者植片均透明,其中5例患者术后最佳矫正视力均有不同程度的提高;1例患者术后视力同术前,视力不提高的原因为眼外伤造成的视神经萎缩.6例术后平均角膜内皮细胞密度为(1648±384)个/mm~2.随访过程均未发现有免疫排斥反应发生.结论 不剥除后弹力层的深板层角膜内皮移植术治疗大泡性角膜病变具有安全、有效、操作简便等特点,有望成为治疗该病的手术方式之一.

Preliminary clinical study of non-Descemet stripping endothelial keratoplasty for bullous keratopathy

Objective To investigate the feasibility and clinical effect of non-Descemet stripping endothelial keratoplasty for bullous keratopathy.Methods In the prospective consecutive case series,6 patients (6 eyes) with bullous keratopathy at Affiliated Xiamen Eye Center of Xiamen University from September 2007 to January 2009 underwent non-Descemet stripping endothelial keratoplasty.During the surgical procedures.the recipient's Descemet membrane and endothelial layer were left untreated.The donor tissue disc consisting of posterior stroma and healthY endothelium from a donor cornea was implanted into the anterior chamber from a limbal tunnel incision,then unfolded and pressed against the recipient cornea with sterile air filled in anterior chamber.All patients were followed up for 6-20 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-uD period.Graft clearance and endothelial cell density (ECD) were observed,too.Results Five donor disc were well adhered to the recipient endothelium and no graft dislocation occurred during the follow-up period.One case showed a narrow gap between the host endothelium and donor disc 1 day postoperatively.This patient was told to stay in prone position and the donor disc readhered well.All the grafts remained transparent until the latest follow-up.Five patients had improved BCVA while 1 patient had the same BCVA.The reason for poor VA was optic atrophy due to trauma.Postoperative mean EDC was (1648±384) cells/mm~2.Conclusions Non-Descemet stripping endothelial keratoplasty for bullous keratopathy is feasible,technically easy,safe and effective.It can be one of the surgical treatment option for bullous keratopathy.