同一供体角膜分别用于全板层角膜移植和深板层角膜内皮移植的临床研究  

Clinical study of using one donor corneal tissue for 2 recipients

作　　者：吴护平[1,2] 董诺[1,2] 李程[1,2] 李学治[1,2] 谢素贞[1,2] 刘昭升[1,2] 刘祖国[1,2] 

机构地区：[1]厦门大学附属厦门眼科中心 [2]厦门大学眼科研究所,361005

出　　处：《中华移植杂志（电子版）》2011年第1期27-31,共5页Chinese Journal of Transplantation(Electronic Edition)

基　　金：国家自然科学基金资助课题(30872809);福建省自然科学基金资助课题(2010D023);厦门市科技计划资助课题(3502Z20094027)

摘　　要：目的探讨同一供体角膜分别应用于全板层角膜移植治疗严重陈旧性眼表烧伤及深板层角膜内皮移植治疗大泡性角膜病变的可行性和临床疗效。方法 2008年1月—2010年1月期间8例严重陈旧性眼表烧伤患者行全板层角膜移植术,8例大泡性角膜病变患者进行不剥除后弹力层的深板层角膜内皮移植术,术后随访6～20个月,观察角膜移植片贴附、生长情况,对手术前后的视力进行比较,检查移植片透明度和角膜内皮细胞密度。结果 8例严重陈旧性眼表烧伤患者术后5眼角膜基本恢复透明,3眼角膜均有不同程度细小新生血管侵入层间。8例大泡性角膜病变患者术后移植片与自体内皮面始终贴附良好,移植片均透明,其中7例患者术后最佳矫正视力均有不同程度的提高,1例术后视力同术前患者为眼外伤造成的视神经萎缩;8例深板层角膜内皮移植术后患者平均角膜内皮细胞密度为(1780±352)个/mm2。结论全板层角膜移植及深板层角膜内皮移植技术使同一供体角膜分别治疗严重眼表烧伤和大泡性角膜病变患者成为可行,且临床疗效较好。Objective To investigate the feasibility and clinical effects of using one donor corneal tissue for large-diameter lamellar keratoplasty and non-Descemet＇s stripping endothelial keratoplasty in 2 patients. Methods In the prospective consecutive case series, 8 patients （8 eyes） with severe ocular burn and 8 patients （8 eyes） with bullous keratopathy at Affiliated Xiamen Eye Center of Xiamen University from January 2008 to January 2010 underwent limbal allograft with large-Diameter＇s lamellar transplantation and non-Descemet＇s stripping endothelial keratoplasty. All patients were followed up for 6-20 months, pre-and postoperative best corrected visual acuity （BCVA） were compared, and the operative status of grafts were monitored during the follow-up period. Graft clearance and endothelial cell density（ECD） were observed. Results All surgical procedures were successfully performed. A stable transparent corneal epithelium was restored in 8 patients with severe ocular bum. In 3 patients, gradual recurrence of peripheral corneal vascu-larization occurred during the follow-up period. Features of graft rejection developed in 2 （25%） of these 8 eyes and best-corrected visual acuity was increased in all eyes after the procedure. In 8 patients with bullous keratopathy, 6 donor discs were well adhered to the recipient endothelium and no graft dislocation occurred during the follow-up period. All the grafts remained transparent until the latest follow-up. Seven patients had improved BCVA while 1 patient remained the same BCVA. The reason for poor BCVA was optic atrophy due to trauma. Postoperative mean ECD was （1780 ± 352） cells/mm2. Conclusion The application of large-diameter lamellar keratoplasty and non-Descemet＇s stripping endothelial keratoplasty techniques may allow use of 1 donor cornea to treat 2 patients with satisfactory effects.

关 键 词：全板层角膜移植 角膜内皮移植 眼表烧伤 大泡性角膜病变 疗效 

分 类 号：R779.6[医药卫生—眼科]