角膜内皮移植治疗穿透性角膜移植术后植片失代偿的长期疗效观察

目的 观察角膜内皮移植手术（EK）治疗穿透性角膜移植术（PKP）后植片失代偿的长期临床效果。设计 回顾性病例系列。 研究对象 选取2008至2010年爱尔眼科医院收治的接受PKP术后植片内皮失代偿的患者6例（6眼）。 方法 对上述患者实施EK手术，对患者的临床资料进行回顾性分析。记录并分析患者术后视力、眼压、内皮细胞密度、排斥反应及并发症等。平均随访时间为（36.17±10.11）个月。主要指标  视力、眼压、内皮细胞密度、排斥反应及并发症。结果 术后所有患者植片均恢复透明，视力较前有不同程度提高，症状缓解。末次随访时，1例患者角膜失代偿，其余5例内皮细胞密度从986~1914个/mm2。随访期内，1例术后1天发生植片半脱位，经再次前房注气后贴附良好；1例术后5个月发生免疫排斥反应，经药物治疗植片保持透明；另1例患者未规律随诊，内皮移植术后26个月时发生排斥反应，导致失代偿。结论 对于反复发生免疫排斥反应导致植片混浊的高危患者，角膜内皮移植手术是可供选择的治疗方法。

Long-term efficacy of endothelial keratoplasty for graft failure after penetrating keratoplasty

Objective To report clinical long-term efficacy of non-descemet stripping endothelial keratoplasty (EK) to treat graft failure after penetrating keratoplasty（PKP）. Design Retrospective cases series.  Participants 6 cases (6 eyes) who accepted EK because of graft failure after PKP in Aier Eye Hospitals from 2008 to 2010. Methods Clinical data of the participants after EK were reviewed retrospectively. The visual acuity, IOP, endothelial density, immune rejection, and complications were recorded. The follow-up time was (36.17±10.11) months. Main Outcome Measures Visual acuity, IOP, endothelial density, immune rejection, and complications. Results In all the 6 cases, corneal grafts restored clarity, visual acuities were improved and symptomes dispeared after EK. One graft dislocated at 1 day after operation, and was reattached by rebuble; one graft was noted with immune rejection at 5th month after operation, and medicine was effective; but immune rejection episodes was noted at another graft at 26th month because of irregular follow-up. The other grafts were clear during the follow-up period. Conclusion EK appears to be a good alternative surgical method for the patients of grafts failure after PKP, especially for high risk patients of immune rejection.