深板层内皮角膜移植术治疗角膜内皮病变

Evaluation of curative effect of deep lamellar endothelial keratoplasty (DLEK) for treating endothelial keratopathy

目的探讨深板层角膜内皮移植术(deeplamellarendothelialkeratoplasty,DLEK)治疗角膜内皮性病变的临床疗效。方法对5例6眼因角膜内皮病变导致角膜水肿或大泡性角膜病变眼行深板层角膜内皮移植术。1眼供、受体角膜和植片均用微型角膜刀制备,另5眼供体深板层内皮植片用微型角膜刀制作,受体带蒂角膜瓣以虹膜恢复器分离制作;其中1例2眼为先天性角膜内皮营养不良,4例4眼为白内障术后大泡性角膜病变。结果4眼随访12个月以上,2眼随访4个月。所有病例角膜持续透明,术后视力均有明显提高,患者术后1个月平均角膜内皮细胞密度为2189/mm2(1594～2641),角膜厚度平均为568μm(510～675)。结论与传统的PKP比较,DLEK具有术后视力恢复快、角膜高度散光机率小、排斥反应风险小等优点,是一种治疗角膜内皮性病变的有效方法。

Objective To study the effect of deep lamellar endothelial keratoplasty （DLEK） for the treatment of endothelial keratopathy. Methods DLEK was performed in five patients （ six eyes ）,among them one patient （2 eyes ） with congenital endothelial dystrophy and four patients （4 eyes ） with bullous keratopathy after cataract surgery. The donor tissue was prepared using microkeratome, and recipient bed was prepared with iris spatula. Results Patients were followed up for 4 to 12 months （mean 7 months） after surgery. All grafts were clear and vision improved in all patients. Endothelial cell density was 2189/mm^2 （1594～2641） ,corneal thickness was 568μm （510～675）. Conclusions Compared with historical PKP, DLEK procedure offers superior outcomes in patients with endothelial keratopathy.