角膜后弹力层剥除自动角膜刀取材内皮移植术后植片脱位的处理  

Management of dislocated graft after Descemet＇s stripping with automated endothelial keratoplasty

作　　者：洪晶[1] 郝燕生[1] 彭荣梅[1] 马志中[1] 

机构地区：[1]北京大学第三医院,北京大眼眼科中心,100191

出　　处：《中国实用眼科杂志》2010年第2期117-120,共4页Chinese Journal of Practical Ophthalmology

基　　金：国家自然科学基金资助（30471865、30871315）

摘　　要：目的探讨角膜后弹力层剥除自动角膜刀取材内皮移植（Descemet’s stripping with automated endothelial keratoplasty，DSAEK）术后植片脱位的原因和处理的方法。方法回顾性研究，在接受DSAEK的48只眼中发生植片脱位的有10例患者，其中2例为晶体摘除后无晶体眼无后囊的病例、8例为人工品状体眼虹膜缺损的病例。7例患者既往有青光眼的病史。DSAEK术后应用裂隙灯显微镜和前节OCT观察植片的位置。植片复位的方法有气泡复位法和黏弹剂复位法，即将气泡或黏弹剂注入到植片的下方，将植片顶起与植床相贴。结果10例患者全部复位成功，其中2例晶体缺如但虹膜正常的患者应用气泡复位成功；另8例人工晶状体眼虹膜缺损的患者应用黏弹剂复位成功。术后早期所有患者眼压均正常，但有3例患者复位手术3周后发生眼压升高。结论DSAEK术后植片脱位是最常见的并发症，气泡复位是最常应用的方法，但对于晶体虹膜隔异常的患者，黏弹剂复位是一种有效地手段。Objective To survey the management of dislocaed graft after Descemet＇ s Stripping with Automated Endothelium Keratoplasty （DSAEK）.To provide experience for DSAEK developing in china. Method Outcomes of 48 DSAEK cases were reviewed retrospectively.10 patients had dislocation of donor graft after DSAEK.Among these, 2 patients were aphakic with integrity iris, while 8 patients were pseudophakic with iris defect.7 patients had history of glaucoma.The position of the graft was checked by slit-lamp microscopy and anterior segment optical coherence tomography.The methods of reposition included bubble and viscoelastic, the procedure was that bubble or viscoelastic was injected to appose the graft further to the recipient surface.Results 10 patients were successfully repositioned.The rebubbling was applied in 2 aphakic cases and the viscoelastic was done in 8 cases who pseudophakic with iris defect.The intraocular pressure （IOP） was normal in 2 week post-reposition in all patients.3 patients occurred high LOP 3 week post-reposition.Conclusions The most complication is dislocation of graft in DSAEK.Rebubbling to reposition graft is a regular method in normal structure eyes, but viscoelastic reattaching the dislocated graft is effective way in abnormal structure eyes after DSAEK.

关 键 词：角膜内皮移植 植片脱位 植片复位 

分 类 号：R776.1[医药卫生—眼科]