角膜后弹力层前内皮移植术治疗角膜内皮功能失代偿的临床观察  

Pre-descement membrane endothelial keratoplasty for treatment of patients with corneal endothelial decompensation

作　　者：黄挺[1] 蒋莉[1] 詹姣[1] 欧阳晨[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》2018年第2期105-110,共6页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金（81351223）

摘　　要：目的探讨角膜后弹力层前内皮移植术（PDEK）治疗角膜内皮功能失代偿的特点。方法回顾性病例系列研究。收集2016年7至12月在中山大学中山眼科中心就诊的角膜内皮功能失代偿患者20例，其中男性8例，女性12例，平均年龄（59.3±11.8）岁。对所有患者行PDEK，采用大气泡技术分离Dua层、后弹力层和内皮层，制作直径为7.75或8.00 mm的PDEK植片，经0.06%锥兰染色后植入患者前房，展平并注入空气固定植片。术后随访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6个月的角膜厚度进行配对t检验。结果采用大气泡技术制作PDEK植片的成功率为90%（18/20）。PDEK手术成功率为90%（18/20）。术后16例（16/18）患者眼前节相干光层析成像术检查结果显示角膜内皮植片贴附平整，仅2例（2/18）患者出现内皮植片脱离。术后6个月时，14例（14/18）患者角膜透明，最佳矫正视力为0.4~1.0。角膜内皮细胞密度为（1 389.3±373.2）个/mm2。术后6个月时中央部角膜厚度为（605±45）μm，与术前（655±56）μm比较差异有统计学意义（t=2.137，P=0.032）。结论PDEK植片制作成功率高，可以减少供体浪费。PDEK植片较容易展平和固定，提高了手术成功率。ObjectiveTo investigate the clinical outcomes of Pre-descement membrane endothelial keratoplasty （PDEK） for treatment of patients with corneal endothelial decompensation.MethodsRetrospective study of case series. The cases of 20 patients （20 eyes） who were diagnosed with corneal endothelial decompensation induced by various original diseases and received PDEK during July 2016 and December 2016 at Zhongshan Ophthalmic Center have been analyzed. The participants included 8 males and 12 females with an average age of （59.3±11.8） years. All 20 patients received PDEK operation, the Dua＇s layer, descement membrane and endothelium of donor tissue were separated from the underlying stroma with the application of big-bubble technique, and donor discs with diameters of 7.75 or 8.00 mm were harvested with scissors. The donor discs were stained with 0.06% trypan blue and loaded on inserters which were then gently inserted into the anterior chamber of the recipient. When the rolled inserted graft was unfolded, air was carefully injected into the anterior chamber underneath the graft so that the graft can attach to the stroma of the recipient. Post-operation follow-ups of over 6 months have been conducted for all patients, the best spectacle corrected visual acuity （BSCVA）, the position of donor disc, corneal thickness and corneal endothelial cell density （ECD） were documented. The pre-operation and post-operation （6 months postoperatively） corneal thickness data of the patients were analyzed with paired sample t test.ResultsThe success rate of preparing PDMEK donor disc with big-bubble technique is 90% （18/20）. Eighteen patients （90%） received PDMEK surgery successfully. Anterior segment optical coherence tomography （AS-OCT） results indicated that sixteen donor discs （16/18） were well attached to the back surface of the recipient stroma, and that two discs （2/18） dislocated at 6 days after surgery. At 6 months post-operatively, the corneas of 14 patients （14/18） turned clear

关 键 词：角膜疾病 内皮  角膜 角膜后弹力层内皮移植术 

分 类 号：R779.6[医药卫生—眼科]