塑料胶片辅助DSAEK术的临床疗效观察  

Observation on the efficacy of plastic slider-assisted donor lenticule implant for DSAEK

作　　者：邓欣然 康黔 丁俭 杨雨昆 黄玉蓉 廖可 王明武[2] 姚晓明 DENG Xinran;KANG Qian;DING Jian;YANG Yukun;HUANG Yurong;Liao Ke;WANG Mingwu;Yao Xiaoming(Department of Ocular&Cornea Diseases,Chengdu Aidi Eye Hospital,Chengdu 610072,China;Department of Ophthalmology,The University of Arizona College of Medicine,Tucson AZ 85721,USA)

机构地区：[1]成都爱迪眼科医院眼表与角膜病科,四川成都610072 [2]美国亚利桑那大学医学院眼科系,图森85721

出　　处：《中国实用眼科杂志》2018年第6期435-439,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的对后弹力层撕除自动板层内皮移植术(DSAEK)的内皮植片植入方式进行改良并观察其临床效果。方法回顾性分析2015年4月至2017年3月改良DSAEK 8例(8只眼)患者的资料。术中采用塑料胶片辅助植入内皮植片,术后随访至少持续3月。术后观察视力、眼压、内皮植片位置、角膜厚度、内皮细胞密度和形态等。结果术后6例角膜内皮植片与植床贴附良好,OCT显示无层间积液积气;眼压正常6例,高眼压2例,均经侧穿切口放气后眼压恢复正常;植片脱位2例,经前房重新注气固定后复位。术后视力0.03~0.6,1例ICE综合征术后12个月因虹膜炎和青光眼致内皮功能失代偿而取出内皮植片改行PKP。术后3个月植片内皮细胞密度减少24%(679.07/2829.43)。结论塑料胶片辅助植入内皮植片有利于简化DSAEK操作步骤、保证手术效果、降低医疗成本,值得推广。Objective To study the efficacy of a modified Descemet stripping automated endothelial keratoplasty(DSAEK)using a plastic glide sheet.Methods The clinical data of 8 patients(8 eyes)who underwent DSAEK due to endothelial failure from April 2015 to March 2017 were collected and analyzed.In these DSAEK procedures,a modified donor lenticel insertion technique was employed using a plastic glide sheet which could be easily crafted out of many surgical materials.All cases were followed up for at least 3 months after surgery.Visual acuity,intraocular pressure(IOP),the thickness of corneal stroma and endothelial cell density of transplanted lenticels were documented and compared before and after surgery.Results Two endothelial grafts detached after surgery,which were successfully re-attached with re-bubbling.OCT showed no gap between donor and recipient in all cases.Seven patients had improved visual acuity.The endothelial cell density of transplants decreased up to 24%(679.07/2829.43)about 3 months postoperatively.High intraocular pressure occured in two patients but returned to normal after anterior chamber puncture.A PKP had to be performed on one patient with ICE due to lenticule descompensation as a result of iritis and glaucoma 12 months postoperatively.Conclusions In the modified DSAEK operation,the plastic glide-assisted lenticule insertion technique not only has achieved good outcome,but also simplified the procedure with reduced cost.Therefore,it should be considered a good alternative techinique for endothelial keratoplasty in developing countries such as China.

关 键 词：角膜移植 后弹力层撕除自动板层内皮移植术 塑料胶片 

分 类 号：R77[医药卫生—眼科]