改良大泡技术辅助的暴露后弹力层深板层角膜移植术(附视频)  

Modified surgical techniques of big bubble deep anterior lamellar keratoplasty (video)

作　　者：高华[1] 贾艳妮[1] 宋鹏[1] 丁刚[1] 李素霞[1] 史伟云[1] 

机构地区：[1]山东省医学科学院山东省眼科研究所山东省眼科医院,济南250021

出　　处：《中华移植杂志（电子版）》2012年第3期6-10,共5页Chinese Journal of Transplantation(Electronic Edition)

基　　金：山东省科学技术发展计划(2012GSF11836);山东泰山学者计划(20081148);山东省优秀创新团队"角膜病的临床及应用基础研究"项目

摘　　要：目的探讨改良大泡技术辅助的暴露后弹力层深板层角膜移植术(DALK)手术技术及技巧,为临床顺利施行DALK提供参考。方法 2011年1月至2012年8月山东省眼科医院对37例(38只眼)角膜基质病变的患者施行大泡技术辅助的暴露后弹力层DALK。改良要点如下:(1)采用负压环钻钻切角膜深度约250μm,一次性角膜刀将前部病变的角膜基质切除;(2)30号穿刺针以10°～30°于旁中央角膜穿刺进入后角膜基质并快速注入无菌空气约1mL,然后采用45°一次性角膜刀将后部基质切除;(3)术中根据情况于角膜缘进行前房穿刺控制眼压;(4)供者角膜剥离后弹力层后覆盖于植床,10-0尼龙线间断(或连续)缝合。结果 37例患者(37只眼)成功接受了DALK,1例斑块状角膜营养不良患者(1只眼)因植床大穿孔改行穿透角膜移植术。术后8例(21.6%)患者出现双前房,1例患者因真菌再次感染行穿透角膜移植术。所有患者角膜移植片透明并与植床贴附紧密,裂隙灯检查难辨层间界面。37例患者(37只眼)最佳矫正视力由术前手动/20cm～0.05提高至术后0.1～1.0(P<0.01)。结论改良大泡技术辅助的暴露后弹力层DALK在达到有效分离后弹力层的同时,降低了术中发生后弹力层破裂的风险,临床安全有效,可扩展临床深板层角膜移植手术的适应证。Objective To evaluate the clinical results of deep anterior lamellar keratoplasty （DALK） assisted by big bubble techniques in the treatment of corneal blindness without endothelium disease. Methods A total of 37 patients （38 eyes） with corneal blindness without endothelium disease successfully received DALK surgery in Shandong Eye Hospital from January 2011 to August 2012. The modifications of surgical techniques include the following： 1 ） After 250 tLm corneal trephination was performed, front lesions in corneal stroma was removed with one-use micro-knife. 2） A 30-gauge disposable needle, bent at 10-30 degrees, was advanced bevel down into the paracentral corneal stroma. About 1 mL sterilized air was injected into the midstroma until a big bubble formed extending to the border of trephination; and then debulking of the anterior residual corneal stroma was performed with 45-degree micro knife baring the Descemet＇s membrane. 3 ） According to the situation during surgery, a peripheral paracentesis was performed to reduce intraocular pressure. 4） After stripping of the Descemet＇s membrane, the donor button was sutured with lO-0 nylon suture. Graft status, visual acuity, and perioperative complications were recorded. Results Thirty-seven patients （37 eyes） received successful DALK surgeries and 1 patient with macular corneal dystrophy returned to penetrating keratoplasty. Eight patients （ 21.6% ） suffered from double anterior chamberand 1 patient （ 1 eye） suffered fungal recurrence and was cured with secondary penetrating keratoplasty. All grafts were clear and were attached closely to the recipients and sht lamp examinations were difficult to distinguish the interface. Best spectacle corrected visual acuity of 37 patients improved from HM/20 cm-0.05 before operation to 0.1-1.0 after surgery （ P 〈 0.01 ）. Conclusions The modified DALK assisted by big bubble techniques effectively separates the Descemet＇s membrane and reduces the risk of the descemet micro-perforation, clinica

关 键 词：深板层角膜移植术 大泡技术 后弹力层 视频 

分 类 号：R779.65[医药卫生—眼科]