角膜后弹力层内皮移植治疗角膜内皮细胞功能失代偿的初步临床观察  

Descemet＇s membrane endothelial keratoplasty for treatment of patients with corneal endothelial decompensation

作　　者：黄挺[1] 欧阳晨[1] 詹姣[1] 蒋莉[1] 

机构地区：[1]中山大学中山眼科中心眼科学国家重点实验室,广州510060

出　　处：《中华眼科杂志》2017年第7期534-539,共6页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金（81351223）

摘　　要：目的 探讨在我国角膜内皮功能失代偿患者行角膜后弹力层内皮移植术（DMEK）的疗效.方法 病例系列研究.对2016年7至9月中山大学中山眼科中心收治的10例角膜内皮功能失代偿患者行DMEK,其中男性2例,女性8例,年龄（54.1±16.4）岁.采用徒手操作从供体角膜剥离出后弹力层和内皮层,形成内皮植片卷,经锥兰染色后用推注器注入患者前房,展平内皮植片后前房注入空气固定植片.术后随访3-6个月,观察视力、内皮植片位置、角膜厚度和内皮细胞密度.对术前和术后3个月的角膜厚度数据进行配对t检验.结果 术后第1天,除1例患者出现角膜植片卷曲需再次行DMEK外,其余9例患者角膜植片在位.术后1个月时,7例患者眼前节OCT提示角膜内皮植片贴附平整,角膜厚度从术前的（680±78）μm下降至（620±67） μm （t=2.677,P=0.025）,角膜后表面结构正常.术后3个月时,6例角膜透明,最佳矫正视力为0.4- 0.8,角膜内皮细胞密度为（1 342.3±436.5）个/mm^2.角膜厚度（612±70）.μm,与术前比较明显下降（t=2.971,P=0.016）.结论 我国角膜内皮功能失代偿患者行DMEK是可行的,能有效改善视力.由于手术难度较大,对眼前节异常的患者应审慎开展.Objective To evaluate the clinical outcomes of Descemet＇s membrane endothelial keratoplasty （DMEK） for treatment of patients with corneal endothelial decompensation in China.Methods Interventional case series.Ten patients （10 eyes） with the diagnosis of corneal endothelial decompensation received DMEK during July 2016 and September 2016 in Zhongshan Ophthalmic Center.Descemet＇s membrane of the donor tissue was carefully stripped from the underlying stroma manually and cut with a 7.75-or 8.0-mm-diameter donor punch.After stained with 0.06% typan blue,the donor disc loaded on an inserter was gently inserted into the anterior chamber of the recipient.When the rolled graft was unfolded,air was carefully injected into the anterior chamber underneath the graft,so that the graft attached to the stroma of the recipient.All patients were followed up for 3-6 months.The best spectacle corrected visual acuity,the status of donor disc,corneal thickness and corneal endothelial cell density were documented and analyzed.Results At 1 day after surgery,1 donor disc presented a rolled edge,and repeated DMEK surgery was performed for this patient.The remaining 9 donor discs presented in place well.At 1 month after surgery,7 donor discs were found to well attach to the back surface of the recipient stroma with normal corneal posterior surface using anterior segment optical coherence tomography.The average corneal thickness reduced to （620±67）μm from preoperative （680±78.3）μm （t=2.677,P=0.025）.At 3 months after surgery,6 patients achieved clear corneas with best spectacle corrected visual acuity ranging from 0.4 to 0.8.The endothelial cell density was 1 342.3±436.5 （872 to 1 933）cells/mm^2 in the patients with clear corneas.The average corneal thickness reduced to （612±70）μm （t=2.971,P=0.016）.Conclusions DMEK could improve visual acuity for corneal endothelial decompensation,but there were more technical difficulties in Chinese eyes.

关 键 词：角膜疾病 角膜后弹力层内皮移植术 可行性研究 

分 类 号：R779.6[医药卫生—眼科]