两种常见的角膜深板层内皮移植术的临床对照研究

A primary contrast clinical study on two different methods ofendokeratoplasty

目的对照研究两种常见的角膜深板层内皮移植术的适应证、技术特点、手术效果、并发症及其处理。方法对A组6例角膜内皮失代偿患者，实施了在角膜瓣下进行角膜深板层内皮移植术。B组9例同样患者实施了在角膜基质袋内进行的角膜深板层内皮移植术。术后追踪观察并发症以及最佳矫正视力、角膜散光、角膜厚度和角膜内皮细胞密度。结果A组，术后6个月，5例患者视力明显提高。平均散光（2．16±0．89）D。平均角膜厚度（546±58．8）μm。平均内皮细胞密度为（2480±214）个／mm^2。B组，随访6个月，所有患者最佳矫正视力不同程度地提高。平均散光（1．19±0．48）D。平均角膜厚度（533±51．7）μm。平均内皮细胞密度为（2124±278）个／mm^2。结论两种角膜深板层内皮移植术均无严重的难以克服的并发症。在角膜瓣下进行的角膜深板层内皮移植术，比较适用于有晶体眼。在角膜基质袋内进行的角膜深板层内皮移植术对于早期的角膜内皮失代偿患者，术后屈光效果较好。适用于无晶状体眼、人工晶状体眼和同时需要进行白内障手术的患者。两种术式均适合我国患者的特点。

Objective To observe the indication , surgical principle , clinical results and complications of the two methods of endokeratoplasty by contrast clinical study. Methods 15 patients with corneal endothelial decompensation were involved. Group A, 6 patients, underwent endokeratoplasty under an anterior lamellar cornea flap. While group B, 9 patients, underwent endokeratoplasty in a corneal stroma pocket. The best corrected visual acuity, astigmatism, corneal pachymetry and corneal endothelial cell density were measured postoperatively. Results At the 6th postoperative month, the best postoperative corrected visual acuity of 5 patients of group A improved obviously. Astigmatism of group A averaged （2.16± 0.89）D. Pachymetry averaged （ 546 ± 58.8 ） μm. Corneal endothelial cell density averaged （ 24803±214 ） cells/mm^2. The best postoperative corrected visual acuity of most patients in group B improved. Astigmatism of group B averaged （ 1.193±0.48）D. Pachymetry averaged （533 3± 51.7）μ m. Corneal endothelial cell density averaged （2124 3± 278）cells/mm2. Conclusion There was no serious complication of the two methods of endokeratoplasty. Endokeratoplasty under an anterior lamellar cornea flap is safer for phakia. Endokeratoplasty in a corneal stroma pocket is a better choice for aphakia, pseudophakia or patient who needs a cataract surgery in the same time. Both of the methods are suitable for Chinese patients.