低渗水肿钝性分离法在深板层角膜移植中的应用  

Deep anterior lamellar keratoplasty by hypisotonic edema and blunt dissection(video)

作　　者：马慧香[1] 陈蔚[1] 邓姿峰[1] 孙莉[1] 

机构地区：[1]温州医学院附属眼视光医院,325030

出　　处：《中华移植杂志（电子版）》2011年第1期32-35,共4页Chinese Journal of Transplantation(Electronic Edition)

摘　　要：目的评价应用低渗水肿钝性分离法的深板层角膜移植术治疗部分角膜疾病的临床疗效。方法回顾性分析2007年11月—2010年5月期间在温州医学院附属眼视光医院接受深板层角膜移植术患者109例(109眼)临床资料。所有患者在移植术中均采用无菌注射用水和钝性器械辅助分离的方法,移植供体为甘油冷冻保存的角膜移植片。术后随访6个月～1年,观察角膜移植片愈合情况、末次随访最佳矫正视力,分析术中植床穿孔率、术后双前房现象、移植片排斥反应率、原发病复发、高眼压及青光眼等并发症情况。结果所有患者术后最佳矫正视力均较术前有所提高,达到或超过0.4者89眼,0.1～0.3者16眼,低于0.1者4眼。有4眼发生后弹力层微小穿孔(3.67%),术后双前房现象在1～2周内消退。角膜上皮延迟愈合2眼,原发病复发4眼(单纯疱疹病毒性角膜炎2眼、细菌性角膜炎1眼、真菌性角膜炎1眼),一过性高眼压1眼,经治疗均得到良好控制。无内皮型排斥反应、继发性青光眼和白内障发生。结论低渗水肿钝性分离法在深板层角膜移植中对治疗因角膜基质混浊而致盲的角膜疾病疗效确切,手术难度降低,并发症减少,故而更易推广。Objective To evaluate the therapeutic effect of modified nkanual deep anterior lamellar keratoplasty （DALK） by hypisotonic edema and blunt dissection. Methods The clinical data of 109 consecutive patients （ 109 eyes） who underwent DALK using glycerin cryopreserved corneal tissues from November 2007 to May 2010 in the Optometry and Eye Hospital of Wenzhou Medical College were reviewed. Postoperative restitution of graft, corrected distance visual acuity （ CDVA ）, original disease recurrence, intraoperative Descemet membrane perforation, and other complications were recorded. Results The CDVA of ＇all patients were improved after surgeries. CDVA better than 0.4 was achieved in 89 cases, while CDVA of 0. 1 to 0.3 was noted in 16 cases, and CDVA worse than 0. 1 was seen in 4 cases. No allograft rejection, secondary glaucoma and cataract were noted in our study. The main complications included 4 cases of Descemet membrane microperforation, 2 cases of persistent corneal epithelium defection, 4 cases of original disease recurrence, and 1 case of temporary ocular hypertension. Conclusion The manual DALK with sterile water for injection and blunt instruments is safe and efficient, which could ease the technique of keratoplasty and decrease the incidence of postoperative complication.

关 键 词：深板层角膜移植术 甘油冷冻保存 低渗水肿 钝性分离 

分 类 号：R779.65[医药卫生—眼科]