角膜移植术后供体角膜内皮细胞的变化

Variation of corneal endothelium of donor with keratoplasty

目的用角膜内皮显微镜对穿透性角膜移植的供眼及术后移植片定期进行内皮细胞摄相观察,探讨供眼角膜内皮细胞的变异情况以及影响其变异的因素。方法选择做穿透性角膜移植的15例病人,用角膜内皮显微镜对术前供眼及术后植片进行定期内皮细胞密度、平均细胞面积、细胞大小变异系数(CV值)及细胞形态方面检查分析。结果(1)术后2～6周、3～6个月、7～11个月及1～1.5年的内皮细胞丧失率分别为12.17%、21.91%、26.55%及29.28%。(2)供眼角膜内皮细胞的平均细胞面积由术前的457.06μm2逐渐增加到术后1～1.5年的646.34μm2,CV值由52.42%增加到62.32%。(3)供眼六角形内皮细胞的比率由术前的41.76%下降到术后1～1.5年的28.08%。结论穿透性角膜移植术后供眼角膜内皮细胞密度逐渐减少,细胞丧失率逐渐增大,术后3～6个月增大最明显,7～11个月变化较小,趋于稳定。平均细胞面积及细胞大小变异系数均逐渐增大。标准的六角形细胞比例则逐渐变小,非六角形细胞的比例相应增大。穿透性角膜移植术后,植片均能透明愈合,且角膜厚度在正常范围内,并获得良好视力,因此其是使角膜病失明患者复明的重要手段。

Objective To investigate changes in the human corneal endothelium of donor eyeballs and postoperative grafts with advanced wild field specular microscope.Methods Endothelial cell density(ECD),average cell area,coefficient of variation of cell area(CV) and percentage of hexagonal cell were compared for 15 donor corneas that underwent a penetrating keratoplasty.The preoperative data were compared with those obtained in postoperative 2～6 weeks,3～6 months,7～11 months and 1～1.5 years.Results (1)The loss rates of the corneal endothelium were 12.17%,21.91%,26.55% and 29.28% in postoperative 2～6 weeks,3～6 months,7～11 months and 1～1.5 years respectively.(2)The average cell area of the donor corneal endothelium increased from preoperative 457.06μm^2 to 646.34μm\+2 in 1～1.5 years postoperatively.The CV increased from 52.42% to 62.32%.(3)The percentage of hexagonal cells of donor corneal endothelium decreased from 41.74% to 28.08% after operation 1～1.5 years.Conclusions (1)After penetrating keratoplasty,the density of donor corneal endothelium decreased,but the loss rates of corneal endothelium increased especially after operation 3～6 months,and did less postoperatively 7～11 months.The average cell area and CV increased gradually.The percentage of standard hexagonal clls decreased and the non-hexagonal cells increased.(2)All grafts were transparent,and corneal thickness was in the normal range,and had good correct acuity vision on penetrating keratoplasty.So that operation is important means for treating corenal leucoma and other diseases.