移植物厚度对角膜内皮失代偿行简易后弹力层角膜内皮移植效果的影响  

Impact of graft thickness on corneal endothelial decompensation following simple Descemet’s stripping endothelial keratoplasty

作　　者：巴颜红 高明宏 陈颖欣 Ba Yanhong;Gao Minghong;Chen Yingxin(General Hospital of Northern Theater Command,Shenyang 110000,Liaoning Province,China)

机构地区：[1]中国人民解放军北部战区总医院,辽宁省沈阳市110000

出　　处：《中国组织工程研究》2025年第6期1199-1207,共9页Chinese Journal of Tissue Engineering Research

摘　　要：背景:研究表明较薄移植物视力恢复更快、排斥风险更低,国内缺乏对内皮移植术后不同植片厚度的临床疗效分析,因此,确定最佳移植物厚度对于提高手术疗效至关重要。目的:评价简易后弹力层剥离内皮角膜移植术后不同植片厚度对视力恢复及其他预后指标的影响。方法:选取2013年1月至2023年2月在北部战区总医院接受简易后弹力层剥离内皮角膜移植手术治疗的角膜内皮失代偿患者共72例(72眼),其中薄植片组(<100μm)32例(32眼),厚植片组(≥100μm)40例(40眼)。随访1年,观察两组术前及术后1,3,6,12个月的最佳矫正视力,术后1年角膜内皮细胞数、角膜植片透明度、术后并发症、植片生存情况。结果与结论:①两组患者术后视力较术前均有显著提高,薄植片组患者术后3个月最佳矫正视力优于厚植片组(P<0.05);②两组术后1年角膜内皮细胞数及植片透明度比较差异无显著性意义(P>0.05);③两组患者继发性青光眼、植片免疫排斥、植片移位等术后并发症发生率比较差异无显著性意义(P>0.05);④两组术后1年植片生存率比较差异无显著性意义(93.8%,92.3%,P>0.05);⑤结论:简易后弹力层剥离内皮角膜移植术是一种安全有效的角膜内皮移植手术方式,其术后疗效与传统后弹力层剥离内皮角膜移植术相似,而且植片植入方式更为简便。较薄植片能够更早提供最佳矫正视力,更早完成角膜重塑,因此在治疗角膜内皮失代偿疾病时,优先选择薄移植物来提高恢复时间。BACKGROUND:Studies have shown that vision recovery with thinner grafts is faster and the risk of rejection is lower.In China,there is a lack of clinical efficacy analysis of different graft thicknesses after endothelial transplantation.Therefore,determining the optimal graft thickness is crucial for improving surgical efficacy.OBJECTIVE:To evaluate the effects of different graft thickness on vision recovery and other prognostic indexes after simple Descemet’s stripping endothelial keratoplasty.METHODS:A total of 72 patients(72 eyes)with corneal endothelial decompensation who received simple Descemet’s stripping endothelial keratoplasty at the General Hospital of Northern Theater Command from January 2013 to February 2023 were selected.There were 32 cases(32 eyes)in the thin graft group(<100μm)and 40 cases(40 eyes)in the thick graft group(≥100μm).The best corrected visual acuity,corneal endothelial cell count,corneal graft transparency,postoperative complications and graft survival were observed in both groups before and 1,3,6,and 12 months after surgery.RESULTS AND CONCLUSION:The visual acuity after surgery was significantly improved in both groups,and the best corrected visual acuity 3 months after surgery in the thin graft group was better than that in the thick graft group(P<0.05).There was no significant difference in the number of corneal endothelial cells and graft transparency between the two groups 1 year after surgery(P>0.05).There was no significant difference in the incidence of postoperative complications such as secondary glaucoma,graft immune rejection and graft displacement between the two groups(P>0.05).There was no significant difference in the 1-year survival rate of grafts between the two groups(93.8%vs.92.3%,P>0.05).To conclude,simple Descemet’s stripping endothelial keratoplasty is a safe and effective surgical method for corneal endothelial transplantation,and its postoperative efficacy is similar to that of traditional Descemet’s stripping endothelial keratoplasty,and the graft

关 键 词：后弹力层撕除角膜内皮移植术 角膜内皮失代偿 继发性青光眼 植片移位 原发移植失败 植片排斥 角膜内皮细胞数 角膜移植 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R496