前房气体介导下的深板层角膜移植术

Air-Guided repeatable manual dissected deep lamellar keratoplasty

目的探讨前房气体介导下可重复切的深板层角膜移植术的临床疗效。方法对41例（41只眼）行此改良的深板层角膜移植术。其中角膜炎反复发作所致混浊累及深层基质者22只眼、化学伤或热烧伤所致混浊累及深层基质者12只眼、完成期圆锥角膜4只眼、累及深层基质的角膜营养不良2只眼及角膜变性1只眼。术后以裂隙灯显微镜观察患眼角膜植片的转归、原眼表疾病的预后、角膜层间的透明度、新生血管的侵入、后弹力层破口的闭合、视力和眼内炎性反应的情况。结果在41只患眼中，有31只眼完整的暴露了后弹力层，有6只眼的部分基质瘢痕与后弹力层不能完整分开；另4只眼在分离近中央部深层基质和后弹力层时，发生穿孔。术后有1只眼发生了严重的前房毒性反应。随访期内无其他严重并发症发生。结论前房气体介导下手法分次切的深板层角膜移植术安全有效。

Objective To investigate the clinical outcomes of air-guided repeatable manual dissected deep lamellar keratoplasty. Methods 41 cases with 41 eyes were operated by the modified deep lamellar keratoplasty. Among all the cases, 22 eyes were with deep stromal opacity caused by intractable keratitis, 12 eyes were with deep stromal opacity caused by chemical or thermal burns, 4 eyes were keratoconus in the advanced stage but with no history of acute hydrops, 2 eyes with progressive cornea dystrophy and 1 eye with cornea degeneration. Slit-lamp microscope was used to observe changes of the cornea button, primary diseases＇ prognosis, intrastromal clearness, neovascularization, closing of the disrupted descemet＇s membrane, visual acuity and intraocular inflammation. Results A complete successful exposure of the descemet＇s membrane were acquired in 31 eyes. In 6 eyes, the deep stromal scarring could not be completely dissected from the descemet＇s membrane. In 4 eyes, mircopunctures happened When dissection reached to the paracentral region, an acute toxic anterior segment syndrome was found in one of them. There were no other severe complications during follow-up. Conclusions The air-guided repeatable manual dissected deep lamellar keratoplasty is safe and effective.