大泡性角膜病变的眼外科处理

目的：寻求一种安全有效的手术方案，使大泡性角膜病变获得增视或解除痛苦的临床效果。方法：对角膜表面羊膜贴敷、角膜基质热凝 羊膜贴敷、角膜层间羊膜植入、角膜层间晶状体后囊膜植入、角膜层间前囊膜植入、角膜内皮板层移植等6种术式共40只眼作回顾性临床研究。结果：角膜表面羊膜贴敷术中58％(7／12)、角膜层间羊膜植入75％(3／4)刺激症状消失或减轻；角膜基质热凝 羊膜贴敷100％(8／8)大泡消失，但视力无改善；角膜层间晶状体后囊膜植入100％(10／10)和前囊膜植入100％(4／4)大泡消失伴视力轻微改善；角膜内皮板层移植100％(2／2)大泡消失，角膜恢复透明并获得0．3以上视力。结论：单纯的羊膜贴敷不足以阻止角膜基质水肿和上皮大泡形成；角膜基质热凝造成的瘢痕能阻止上皮大泡形成。但无助于视力的改善；晶状体前／后囊膜具有良好的物理性屏障作用，能够减轻角膜基质水肿和阻止上皮大泡形成，但仍难获得有用视力；带有活性内皮的内皮板层移植，帮助受体重获内皮的物理性屏障功能和代谢性泵功能，角膜透明的生理属性得以恢复，是一种安全的增视性手术。

Surgical management of bullous keratopathy

Objective:To explore an effective and safe surgical style for the treatment of bullous keratopathy. Methods:A retrospective clinical research was run.Six surgical styles including amniotic membrane patching(AMP),stromal thermocoagulation(ST)combined AMP,amniotic membrane patching in lamellae(AMPIL),posterior crystalline capsule transplantation in lamellae(PCCTIL),anterior crystalline capsules transplantation in lamellae(ACCTIL),deep lamellar endothelial keratoplasty(DLEK)were performed in 40 patients with bullous keratopathy. Results:Stimulation symptoms disappeared or reduced in 58%(7/12)of AMP and 75%(3/4)of AMPIL.Bullous keratopathy removed with no improved visual acuity was in 100%(8/8)of ST combined AMP.Bullous keratopathy disappeared with visual acuity improved in 100%(10/10)of PCCTIL and 100%(4/4)of ACCTIL.Bullous keratopathy disappeared with corneal transparency recovered and visual acuity improved to more than 0.3 was in 100%(2/2)of DLEK. Conclusions:AMP was not enough to remove bullous keratopathy and stromal swelling.Stromal scaring results from corneal stromal thermocaogulation could prevent bullous keratopathy but visual acuity was not improved.Posterior and anterior crystalline capsule posses good physical barrier function which reduced stromal swelling and prevent formation of bullous keratopathy but the visual acuity was not improved to useful level.DLEK could recover corneal transparency because the physical barrier function and endothrlial fluid pump function could be reestablished by corneal endothelium with viability,so that DLEK is a safe and optical surgery for bullous keratopathy.