全板层角膜移植联合深板层角膜内皮移植术治疗全角膜病变的初步临床观察

Preliminary outcome of large-dlameter lamellar keratoplasty combined with deep lameilar endothelial keratoplasty for whole cornea destruction

目的探讨用微型角膜刀行全板层角膜移植联合深板层角膜内皮移植治疗全角膜损伤的适应证、手术原则、临床疗效及并发症的预防和处理。方法系列病例研究。收集2005年5月至2006年3月在中山大学中山眼科中心住院患者的临床资料。应用微型角膜刀对11例患者的11只全角膜病损眼实施全板层角膜移植联合深板层角膜内皮移植术治疗，并对患者的术后矫正视力、眼压、中央角膜厚度及角膜内皮细胞密度进行随访观察12—18个月。结果术后3、6及12个月随访检查，11只术眼视力均有提高，针孔矫正视力平均分别为4．4±0．3、4．5±0．3及4．5±0．3；术后1周内术眼的眼压短暂升高，但可用药物控制或缓解，术后3、6及12个月时随访检查术眼的眼压分别平均为（19．8±2．7）、（19．2±1．7）及（19．5±2．0）mmHg；术后3、6及12个月时随访检查的角膜中央厚度分别平均为（538．9±8．9）、（536．3±6．3）及（537．2±6．9）μm；角膜内皮细胞密度在术后3、6及12个月时分别平均为（2519．8±110．7）、（2244．4±137．9）及（2093．3±141．9）个／mm^2。术后主要并发症为两层植片间的间隙，此间隙可于术后1个月内自行消失。结论采用微型角膜刀进行全板层角膜移植联合深板层角膜内皮移植术，可以提高患者视力，并较好地避免术后难治性青光眼的发生，是治疗全角膜损伤的有效术式。

Objective To understand the indication, surgical principle, outcome and complications of large-diameter lameUar keratoplasty combined with deep lameilar endothelial keratoplasty for whole cornea destruction. Methods Eleven hospitalized patients with whole cornea destruction in Zhongshan Ophthalmic Center,Sun Yat-Sen University from May,2005 to March,2006 were involved in this study. Five left eyes and six fight eyes underwent large-diameter larneUar keratoplasty combined with deep lameUar endothelial keratoplasty. The patients were followed up for 12 to 18 months and their pinhole postoperative visual acuity, intraocular pressure, pachymetry of the central cornea and corneal endothelial cell density was recorded. Results The pinhole postoperative visual acuity of all patients improved and averaged separately 4. 4 ±0. 3, 4. 5 ±0. 3 and 4.5 ± 0. 3 at the 3rd, 6th and 12th postoperative month. There was a temporary increase of the postoperative intraocular pressure within one postoperative week which can be controlled by medication and released soon. And the postoperative intraoeular pressure averaged （ 19. 8 ± 2. 7 ）, （ 19.2 ± 1.7） and （19.5 ±2. 0） mm Hg respectively at the 3rd,6th and 12th month postoperatively. At the same following up times, the pachymetry of the central cornea averaged （ 538.9 ± 8.9）, （ 536. 3 ± 6. 3 ） and （537. 2 ± 6.9） μm respectively and the corneal endothelial cell density averaged （2519. 8 ± 110. 7）, （2244. 4 ± 137.9） and （2093.3 ± 141.9） cells/mm^2 respectively. The main complication was the interspace between the two lamellar grafts and it would disappear automatically within one postoperative month. Conclusions Large-diameter lamellar keratoplasty combined with deep lamellar endothelial keratoplasty can avoid postoperative glaucoma. It may offer further advantages over traditional surgery to treat whole cornea destruction.