选择性角膜内皮移植术

Selective corneal endothelial trans-plantation

长期以来,治疗角膜内皮病变标准的方法为穿透性角膜移植术(PK)。虽然总体上说,PK手术成功率高,但由于术后视力恢复时间长,且可出现多种并发症,如高度散光/不规则散光、植片排斥反应以及与缝线和切口愈合相关的并发症等,因此并非一种理想的手术方式。过去十几年内,出现了多种选择性角膜内皮移植术,如经角膜瓣途径的内皮移植术、经角巩膜袋途径的内皮移植术及带活性内皮细胞的Descemet’s膜移植术等。与PK手术相比,这些新的手术方法理论上有着多方面的优势,初步的临床结果亦令人鼓舞,有可能成为替代传统PK手术治疗角膜内皮病变的更有效的方法。

· Penetrating keratoplasty (PK) has been the standard procedure in the treatment of corneal endothelial disorders, such as Fush's endothelial dystrophy and pseudophakic bullous keratopathy. Although PK is a successful operation in general,it is not an ideal approach because of the prolonged visual recovery and other postoperative complications, such as high/irregular postoperative astigmatism, graft rejection and problems related to suture or incision healing. During the last decade, several novel approaches have been developed, including deep lamellarendothelial keratoplasty (DLEK) under a corneal flap, DLEK through a sclerocorneal pocket incision, and transplantation of the Descemet's membrane with its end othelium. These techniques offer several theoretical advantages, and the initialclinical results are promising. They may become effective alternatives to conventional PK for patients with endothelial dysfunction.·