完全钝性基质层间分离的深板层角膜移植术

Deep anterior lamellar keratoplasty by a new complete muticous intrastromal separation

目的介绍一种虹膜恢复器辅助的完全钝性基质层间分离的深板层角膜移植术，并评估应用该术式治疗各种角膜病的有效性和安全性。方法通过激光共聚焦显微镜检查，选择角膜病变深度未达后弹力层，内皮功能正常的各类角膜病患者35例35只眼。通过虹膜恢复器辅助的完全钝性基质层问逐层分离的方式行深板层角膜移植，并对其疗效进行观察、分析。结果35只眼中，2只眼（5．71％）有小的钝性撕裂，在保留少量深基质后均能继续完成手术；术后2只眼（5．71％）出现双前房，3d内均自行吸收；细菌和真菌性角膜溃疡术后均未复发。其中18只眼拆线后两周视力高于0．5（约占51．4％），25只眼高于0．3（约占71．4％）。术后角膜地形图散光呈现递减的趋势，角膜内皮细胞密度无明显下降。术后6个月角膜植片均透明愈合，无明显层问混浊。结论通过虹膜恢复器辅助的基质层间钝性分离的深板层角膜移植术是一种安全有效的手术方式。激光共焦显微镜检查可活体检查角膜各层组织结构，可为深板层角膜移植术提供良好的客观依据。

Objective To evaluate the efficacy and safety of the deep anterior lamellar keratoplasty （DALK）in the treatment of keratonosus through a new surgical technique-complete muticous intrastromal separation assisted by iris repositor.Methods Through complete muticous intrastromal separation,DALK was performed in 35 patients （35 eyes）of keratonosus without endothelial abnormalities.The effectiveness of operation was clinically observed and evaluated.Results During surgery, two eyes （5.71%）had mini-rupture of the DM and were finished by reserving few deep stroma.Two eyes （5.71% ）occurred double anterior chamber after surgery and were absorption in three days.All of bacterial and fungal keratitis was not occurred recurrence.Eighteen cases of bacterial and fungal keratitis were not occurred recurrence.Eighteen cases of BCVA were over 0.5 （51.4%）and 25 cases were over 0.3 （71.4%）at two weeks after suture removal.Topographic astigmatism showed a decrease tendency, but endothelium cell density were not evident change at different postoperative times.Kerato-graft was clarity without evident intrastromal opacity at 6 month after surgery.Conclusions The DALK by complete muticous intrastromal separation is a safe and effective therapy in the treatment of keratonosus.Laser Confocal Microscopy enables precise evaluation of corneal features, provide a favorable objective evidence for DALK.