深板层与穿透性角膜移植术后角膜内皮细胞密度的比较研究

Comparison of Endothelial Cell Density after Deep Lamellar keratoplasty and Penetrating keratoplasty

目的研究穿透性角膜移植术(Penetrating keratoplasty,PKP)和深板层角膜移植术(Deeplamellar keratoplasty,DLKP)术后不同时间角膜内皮细胞密度(Endothelial cell density,ECD)的变化情况,以明确这两种术式对移植术后角膜内皮细胞变化的影响。方法采用非接触角膜内皮显微镜(Specular microscopy)及细胞图像分析系统(I MAGEnet2000)连续采集分析17例穿透性角膜移植及13例板层角膜移植术角膜内皮细胞情况,观察术后患者1、3、6、12及24个月时的角膜内皮细胞变化情况。并对结果进行统计学分析。结果17例(眼)PKP术前供体的角膜内皮细胞平均密度为(3390.4±259.5)个/mm2,术后1个月为(3073.7±392.1)个/mm2,术后3个月为(2834.0±456.1)个/mm2,术后6个月为(2591.2±366.7)个/mm2,术后12个月为(2180.6±250.8)个/mm2,术后24个月为(1820.5±198.2)个/mm2。13例(眼)DLKP术前患者健眼的内皮细胞平均密度为(3442.7±178.7)个/mm2,术后1个月为(3224.3±315.4)个/mm2,术后3个月为(3062.2±277.2)个/mm2,术后6个月为(2978.3±287.3)个/mm2,术后12个月为(2968.3±312.9)个/mm2,术后24个月为(2888.5±296.7)个/mm2。结论深板层角膜移植内皮细胞丢失速率较穿透性角膜移植小,术后细胞存活数目较穿透性角膜移植多。

Objective To investigate the early changes of endothelial cell density after deep lamellar keratoplasty and penetrating keratoplasty with non-contact specular microscope. Methods Longitudinal observation of 17 consecutive penetrating ketatoplasties （PKP） and 13 deep lamellar keratoplasties （DLKP）. At 1, 3, 6, 12, 24, months after surgery, specular microscope was performed to evaluate the endothelial celll density. Results The endothelial density in the 17 eyes after penetrating keratoplasties were 3390.4±259.5, 3073.7±392.1, 2834.0±456.1, 2591.2 ± 366.7, 2180.6 ± 250.8, 1820.5 ± 198.2 presurgery and after 1, 3, 6, 12 and 24 months; The endothelial density in the 17 eye after deep lamellar keratopla.atoplasties were 3442.7 ± 178.7, 3224.3 ± 315.4, 3062.2 ± 277.2, 2978.3 ± 287.3, 2968.3 ±312.9, 2888.5 ± 296.7 presurgery and after 1, 3, 6, 12 and 24 months. Conclusions After keratoplasty the endothelial cell loss rate increased, penetrating keratoplasty loss more endothelial cells than deep lamellar keratoplasty.