前部深板层角膜移植治疗急性圆锥角膜的临床研究  

Clinical study on surgical treatment of keratoconus acute hydrops with deep anterior lamellar keratoplasty.

作　　者：鲍连云 秦勤 向双明 卞征 

机构地区：[1]南京宁益眼科中心,210008

出　　处：《中华眼外伤职业眼病杂志》2011年第6期407-412,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的评价前部深板层角膜移植术治疗急性圆锥角膜的效果。方法采用临床病例观察方法。分析在南京宁益眼科中心接受前部深板层角膜移植术的急性圆锥角膜5例（5只眼）。采用前房注气联合逐步板层分离技术，植床直径7．5～8．0mm。供体为新鲜和冷冻保存角膜。观察术前和术后1、3、6个月和1年以上裸眼视力、矫正视力、移植片透明性、中央区角膜厚度、中央角膜内皮细胞密度和形态以及排斥反应发生的情况。结果术前视力：手动／5～10cm，术后1年平均裸眼视力0．26±0．16，平均最佳矫正视力0．42±0．23；平均球镜度（-2．75±0．94）D，柱镜度（-2．56±0．83）D；术前平均中央角膜厚度（279．33±312．30）μm，术后1年厚度为（557．20±37．48）μm；术前角膜内皮细胞形态和计数不能测量，术后3个月至术后1年内皮细胞数量无明显变化，中央角膜平均内皮细胞计数（1967±228．51）个／mm^2；新鲜植片透明性高于保存植片；超声生物显微镜检查：术前病变角膜向前隆起，基质层有囊泡结构，纤维成分减少，回声增强；术后以上改变均消失。术中2眼发生后弹力层微小穿孔，但没改变术式；术后无双前房或排斥反应发生。结论急性圆锥角膜可不造成角膜内皮细胞数量、形态的严重损害：采用前部深板层角膜移植治疗急性圆锥角膜短期临床效果良好。Objective To evaluate the efficacy of deep anterior lamellar keratoplasty （DALK） in patients with keratoconus acute hydrops. Methods In a prospective, consecutive clinical cases trail. Five keratoconus acute hydrops patients were scheduled for DALK in Nanjing Ning-Yi Eye Center. The donor corneae included fresh and eryopreserved allogeneic bank eyes. Surgerical techniques were air bubble injection to anterior chamber and layer by layer removal of lamellar tissue. The follow-up examinations included visual acuity（VA）, best corrected VA, biomicroscopy, ultrasound pachymetry, specular microscopy, which were measured and recorded at 1,3,6 and over 12 months postoperatively. Results Average VA was HM/5 N 10 cm preoperatively, and after operation, average VA was 0.26 ±0.16, mean best corrected VA was 0.42 ± 0.23, mean spherical diaopter was （ - 2.75±0.94） D, mean cylinder diaopter was （ - 2.56 ± 0.83 ） D. Mean central corneal thickness was （279.33 ± 312.30）μm and that was （557.20 ± 37.48） μm at 1 year after operation. The counting of acute hydrop patients＇ corneal endothelium couldn＇ t be achieved before surgery. The mean endothelial cell count was （1967 ±228. 51 ）/mm^2 after surgery. The grafts of fresh corneal donors were better transparent than that of cryopreserved corneae. With ultrasound bio-microscopy technique, acute hydrop corneal anterior surface curvature was higher and there were some small ＇ cysts＇ in stromal layer, fabric component part was decreased and had stronger ultrasound echo, but all above pathological phenomena disappeared after operation. All surgeries were uneventful except two patients in whom the Descemet membrane（DM） mieroperforatiou occurred. But the pseudo anterior chamber and rejection complica- tions did not occurred and the grafts remained stable at 1 year postoperatively. Conclusions The keratoconus acute hydrops could not cause heavy damage of endothelium and DALK is suitable for acute hydrops. Short-term postoperative outcomes are sati

关 键 词：角膜移植 深板层 圆锥角膜急性 

分 类 号：R779.65[医药卫生—眼科]