小切口下角膜后弹力层剥除联合深板层内皮移植术的实验研究

Experimental research of small-incision Descemet＇s stripping endothelial keratoplasty

目的探讨小切口下角膜后弹力层剥除联合深板层内皮移植术（DSEK）的手术方法、疗效、并发症、内皮细胞的评价及组织学检查。方法为实验研究。将24只新西兰大白兔随机分为3组，每组8只兔（8只眼），供体为新西兰大白兔16只眼。A组于角膜缘处行5mm长隧道切口，剥去角膜中央直径10mm的后弹力层，将等大的带有少量基质的后弹力层内皮细胞膜片植入受体眼；B组行单纯角膜后弹力层环形撕除术；C组在角膜后弹力层剥除后行去内皮细胞的带少许角膜基质和后弹力层膜片植入。术后观察1个月，比较3组兔角膜的透明性、植片贴附情况、角膜内皮细胞密度及并发症情况。结果A组8只眼术前角膜内皮细胞密度平均值为（2728±108）个/mm^2，术后角膜均恢复透明，内皮细胞密度平均为（2195±77）个／mm^2，差异有统计学意义（t=12．455，P〈0．001）；组织切片证实角膜内皮细胞植片与受体植床愈合良好，层间无瘢痕形成。B组8只眼术后均有严重的角膜水肿，持续1个月未恢复，组织学检查术后28d时仅在后弹力层剥除的交界处有极少数的内皮细胞长入。C组8只眼术后1周内角膜植片均水肿，5只眼植片脱位；术后至观察1个月，角膜中央水肿仍较明显，伴有角膜新生血管长入，组织学检查植片部位未见内皮细胞长入。结论角膜后弹力层剥除联合深板层内皮移植术具有安全、损伤小、术后恢复快及无层间瘢痕的优点，是治疗大泡性角膜疾病的优选术式。

Objective To investigate the surgical procedure, clinical efficacy, complications, density of endothelial cells and histological changes after Descemet＇s stripping endothelial keratoplasty （DSEK） surgery. Methods It was a experimental study. Twenty four New Zealand rabbits were divided into 3 groups, 8 rabbits per group. Donor grafts were dissected from 16 New Zealand rabbit eyes. Group A was experimental group, a 5 mm limbal tunnel incision was made. Descemet＇s membrane was striped off at 10 mm diameter, then the same diameter donor cornea （including Descemet＇s membrane and endothelium with a little of posterior stroma） was inserted into the recipient＇s anterior chamber. Air was injected into the anterior chamber to press the graft up against the recipient cornea. Group B was the control group, only striped the Descemet＇s membrane at the recipient cornea. Group C was the experiment control group, the procedure was similar to the group A, but the donor graft was without endothelial cells. Results All corneas of group A were transparent, and the mean density of the endothelial cells was （ 2195 ± 77 ）/mm^2 （t = 12. 455, P 〈0. 001 ）. Endothelial grafts attached to the recipients well and no scar formation between them under histological observation. The corneas were severe edema in groups B and C one month after surgery. Condusions DSEK is a safe surgery, can be recovered rapidly with little damages, and without interface scar formation after surgery. DSEK may be the first choice for the treatment of bnllous keratopathy.