飞秒激光辅助角膜内皮移植术治疗大泡性角膜病变的疗效观察

目的：评估飞秒激光辅助的后弹力层撕除角膜内皮移植术治疗大泡性角膜病变的临床疗效及安全性。方法：回顾性分析2013－03／2014－02在我科住院治疗的大泡性角膜病变患者15例16眼，其中男7例7眼，女8例9眼，平均年龄66．3±18．4岁，采用飞秒激光制作薄层角膜内皮植片，进行后弹力层撕除角膜内皮移植术。术后随访12mo，观察角膜刺激症状消退、植片恢复和并发症等情况，观测指标包括最佳矫正视力、眼压、前节光学相干断层扫描及角膜内皮细胞计数。结果：所有患者手术顺利，无术中并发症发生；术后眼压正常，最佳矫正视力较术前不同程度提高。角膜刺激症状自术后1d 开始逐渐减轻，术后3wk 完全缓解。术后1眼（6％）发生内皮植片脱位，3眼（19％）植片与植床之间存在局灶性层间积液。术后1 mo角膜上皮变光滑，基质水肿消退，中央角膜厚度（638±86．51μm ）较术前（811±137．55μm）明显变薄。随访期间，发生植片急性排斥反应和植片内皮功能失代偿各1眼（6％）。末次随访，角膜内皮细胞计数为1687±507个／mm2。结论：应用飞秒激光辅助后弹力层撕除角膜内皮移植术治疗角膜内皮病变，可以个体化、精确、高效地制作内皮植片，手术安全性高，术后恢复快。

Observation of femtosecond laser-assisted Descemet's stripping endothelial keratoplasty for bullous keratopathy

Abstract?AIM: To evaluate the clinical effects and safety of femtosecond laser-assisted endothelial keratoplasty in bullous keratopathy.?METHODS:It was a retrospective case series study. Fifteen consecutive patients ( 16 eyes ) with bullous keratopathy at Nanjing General Hospital of Nanjing Military Command underwent Descemet's stripping endothelial keratoplasty whose donor grafts were dissected by a femtosecond laser from March 2013 to February 2014.The corneal irritation symptoms and the attachment of endothelial grafts were evaluated during the 12mo follow -up period. Clinical data of the best -corrected visual acuity, intraocular pressure, anterior segment optical coherence tomography and endothelial cell count were reviewed.?RESULTS: The surgical procedures for all the cases were successful and no intraoperative complication developed. The corneal irritation symptoms began relieving on 1d postoperatively and fully recovered in 3wk and never relapsed during the follow-up period. The grafts were well attached to the host except for one dislocation ( 6%) which was relocated and well attached afterward.Fluid leakage between the local graft-host interface occurred in three eyes ( 19%) and absorbed spontaneously in 3wk.At postoperative 1mo, the corneal epithelium became smooth and the edema of corneal stroma dissolved.The central corneal thickness thinned out from preoperative 811±137.55μm to postoperative 638± 86.51μm.During the follow-up period, acute rejection and graft endothelial decompensation was observed in one eye ( 6%) respectively. At the final follow -up, endothelial cell density was 1687±507cells/mm2.? CONCLUSION: The femtosecond laser -assisted Descemet's stripping endothelial keratoplasty is a safe and effective technique for corneal endothelial decompensation, which may yield thin individualized grafts efficiently and precisely.