DCD角膜移植术后角膜内皮细胞的变化

Changes of Corneal Endothelial Cells after DCD Corneal Transplantation

目的探讨心脏死亡供体器官捐献(donation after cardiac death,DCD)来源角膜植片行穿透性角膜移植后角膜内皮细胞变异情况.方法用角膜内皮显微镜对心脏死亡供体来源角膜植片行穿透性角膜移植191例眼术后角膜植片分别于术后1~4周;5~12周;4~6月;7~12月行角膜内皮镜检查.结果 (1)191例患者中有48例患者角膜内皮镜检出,143例患者角膜内皮镜无法检出,检出率占25%;(2)48例患者术后1~4周、2~3月、4~6月及7~12月的内皮细胞细胞密度(2271.15±321.47)个/mm^2、(1971.33±358.18)个/mm^2、(1826.59±303.92)个/mm^2、及(1753.14±306.31)个/mm^2.平均细胞面积由术前的(388.45±95.26)μm增加到术后7~12月的(638.63±124.73),细胞大小变异系数(cv值)由30.15%增加到65.04%,六角形细胞比例由(52.59±7.26)%下降到(40.01±11.35)%.结论 (1)角膜内皮镜检查对于早期角膜移植术后患者内皮细胞识别率较低,敏感度差,角膜移植术后早期内皮镜无法测出结果时可选择共焦显微镜评价观察角膜内皮细胞的变化;(2)穿透性角膜移植术后供眼角膜内皮细胞密度逐渐减少,六角形细胞比例渐变小平均细胞面积和cv值均渐增大.(3)DCD角膜移植术后1 a,尤其是术后3月应加强术后随访,当发现有早期排斥反应的征象时,及时进行抗排斥治疗对于减少早期排斥反应尤为重要.

Objective To study the variation of corneal endothelial cellsafterpenetrating keratoplasty fromdonation after cardiac death（DCD） .Methods 191 cases of corneal graftwere textedafter penetrating keratoplasty1-4 weeks; 5-12 weeks; 4-6 months; 7-12 months later from donation after cardiac death with cornealendothelial microscope.Results 1.48patients in 191 cases of patients with corneal endothelialmicroscopeweredetected,143 cases of patients could not be detected,the detection rate was 25%;2.48 cases after1 -4 weeks,5-12weeks,4 -6 monthsand7 -12 months the density of endothelial cells were（2271.15±321.47）mm2,（1971.33±358.18）mm2,（1 826.59±303.92） mm2, （1753.14±306.31） mm2,and the average cellarea increased from（388.45±95.26） 滋m to（638.63±124.73） 滋m 7-12 months after operation,cell sizevariation coefficient（CV value ） increased from 30.15% to 65.04%,the proportion of hexagonal cells decreasedfrom 52.59 ±7.26% to 40.01 ±11.35% .Conclusion（1） corneal endothelial endoscopy for early cornealendothelial cells of patients with recognition rate is low, poor sensitivity, confocal microscopy evaluation could be usedinstead of corneal endothelial microsco when the cornea was edema;（2） Corneal endothelial cell density decreased gradually and the percentage of hexagonal cells was descend and CV value were increased afterpenetratingkeratoplasty; （3） Follow-up should be strengthened after penetrating keratoplasty from donation aftercardiac death （DCD） 1a later especially three months later , when there were signs of early rejection,timely antirejection treatment was very important for reducing early rejection.