简化DSEK技术在复杂性大泡性角膜病变中的应用  

Application of simplified DSEK technique in complex bullous keratopathy

作　　者：孙珊珊 高明宏 陈颖欣 刘志玲 Sun Shanshan;Gao Minghong;Chen Yingxin;Liu Zhiling(Department of Ophthalmology,the Third People's Hospital of Changzhou,Changzhou 213001,China;Dalian Medical University,Dalian 116044,China;Department of Ophthalmology,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]江苏省常州市第三人民医院眼科,213001 [2]大连医科大学研究生院,大连116044 [3]北部战区总医院眼科,沈阳110016

出　　处：《眼科》2020年第1期38-42,共5页Ophthalmology in China

摘　　要：目的观察简化的后弹力层撕除角膜内皮移植术(Descemet’s stripping endothelial keratoplasty,DSEK)治疗复杂性大泡性角膜病变的疗效。设计回顾性病例系列。研究对象2015年12月至2017年8月北部战区总医院接受手术治疗的11例(11眼)复杂性大泡性角膜病变患者。方法所有患者接受了DSEK,术中所有供体植片采用手工剖切制作,平均直径(8.05±0.57)mm,植片均采用滑板法植入。主要指标术后早期植片贴附情况及并发症;随访1年时最佳矫正视力(BCVA)、角膜散光、植片透明度和厚度、内皮细胞密度和手术并发症。结果11眼中8眼术后植片与植床贴附良好;3眼术后植片半脱位,经再次前房注气后植片贴附良好。1眼术后4个月继发开角型青光眼。术后1年BCVA 7例患者≥0.3;平均角膜散光度数为(1.83±0.46)D;11眼植片均透明,平均植片厚度(126±19)μm;平均内皮细胞密度(954±218)个/mm2;11眼均无排斥反应发生。结论复杂性大泡性角膜病变行简化DSEK可获得满意的疗效。Objective To observe the efficacy of simplified Descemet’s stripping endothelial keratoplasty(DSEK)in the treatment of complex bullous keratopathy.Design Retrospective case series.Participants 11 patients(11eyes)with complex bullous keratopathy have receipted keratoplasty in General Hospital of Northern Theater Command from December 2015 to August 2017.Methods All cases are treated with DSEK.The grafts were prepared with hand assisted method,and the average diameter was(8.05±0.57)mm.All grafts were implanted with a skateboard.Main Outcome Measures The adherence of the donor lenticule to the recipient posterior stroma and complications were monitored in the early stage after surgery.Best-corrected visual acuity(BCVA),corneal astigmatism,graft transparency and thickness,endothelial cell density(ECD)and surgical complications were recorded in 1 year after surgery.Results In all 11 eyes,8 donor lenticules were well adherence to the recipient posterior stroma and 3 graft dislocations occurred at the early postoperative term.One eye was diagnosed with secondary open-angle glaucoma at the postoperative 4 month.Postoperative BCVA was 0.3 or more in 7 eyes,and mean corneal astigmatism was(1.83±0.46)D.All grafts kept clearance during 1 year follow-up period,and the average graft thickness was(126±19)μm.No immune rejection episodes were recorded.The average ECD was(954±218)/mm2.Conclusion Although the DSEK for complex bullous keratopathy are relative difficulty,it can obtain satisfactory efficacy.

关 键 词：角膜内皮移植 后弹力层撕除角膜内皮移植 大泡性角膜病变 

分 类 号：R779.6[医药卫生—眼科]