改良型角膜内皮移植术治疗大泡性角膜病变

Modified endothelial keratoplasty for bulbous keratopathy

目的 探讨改良型角膜内皮移植术对大泡性角膜病变的临床治疗效果.方法 收集大泡性角膜病变患者20例,按术式不同随机分为2组,每组10例,分别由同一术者行不撕除内皮的改良型深板层角膜内皮移植术(EK)与穿透性角膜移植术(PKP),于术后1、3、6个月及1、2年行视力、眼压、裂隙灯、角膜内皮镜、角膜地形图、眼前节OCT及角膜共聚焦显微镜等检查,对比两组病例术后最佳矫正视力、眼压、角膜散光、角膜厚度和内皮细胞数量及形态,观察两组术后视力、并发症、植片贴附状态、内皮功能及术后排斥等情况,比较两种术式对大泡性角膜病变的治疗效果.结果 EK组在术后随访期间的最佳矫正视力、角膜内皮数量、排斥反应发生等方面,均明显优于PKP组(t=2.9103,P<0.05).结论 改良型角膜内皮移植术相比传统的穿透性角膜移植术在治疗大泡性角膜病变方面,具有局部损伤小,视力恢复好,排斥反应发生率低等优势,值得进行临床推广.

Objective To explore the clinical therapeutic effect of modified corneal endothelium transplantation for bullous keratopathy.Methods Twenty patients with bullous keratopathy were collected in Shenzhen eye hospital during 2009-2012,randomly divided into two groups.There were 10 patients in each group.All the surgeries were performed by the same surgeon.Ten patients in experimental group were carried out the modified endothelium transplantation without endothelium delaceration.The other 10 patients in control group were underwent traditional penetrating keratoplasty (PKP).The visual acuity,intraocular pressure,slit lamp,corneal endothelial mirror,eye anterior segment OCT,corneal topography and corneal confocal microscopy were observed to all the patients at 1 month,3 months,6 months,1 year,and 2 years after operations.And the best corrected visual acuity,intraocular pressure,corneal thickness and endothelial cell number were recorded.The corneal transparency,complications,grafts adhesion,endothelial function and postoperative rejection were monitored.Results The best corrected visual acuity and corneal endothelial numbers of cases in experimental group were more than control group.Significant difference was observed between two groups (t =2.9103,P <0.05).There were seldom postoperative rejection in experimental group during postoperative follow-up.Conclusions The modified endothelium transplantation without endothelium delaceration could be an altered treatment for bullous keratopathy.