正确选择角膜内皮移植的适应证

Focus on the right choice of suitable indications for corneal endothelial transplantation

角膜内皮移植具有许多独特的优点，有望取代穿透性角膜移植成为治疗角膜内皮失代偿的首选术式。然而，内皮移植也存在术后内皮细胞密度偏低的缺陷，而且，我国的大泡性角膜病变主要见于白内障等眼内手术造成的角膜内皮损伤，病情严重且伴多种眼内异常，使角膜内皮移植面临较大的困难，术后内皮细胞密度下降更明显。根据患者的病情特点，选择合适的术式和适应证是保证手术成功的关键。采用一些改良技术也能减轻内皮细胞的损伤，提高手术成功率。

Endothelial keratoplasty （EK） demonstrates many advantages over penetrating keratoplasty （PK）, which is expected to become an initial surgical choice for the treatment of corneal endothelial dysfunction, instead of PK. However, EK also has the defects in the low density of endothelial cells after surgeries. And the bullous keratopathy in China is mainly caused by intraocular surgeries such as cataract extraction, which was accompanied by a variety of intraocular abnormalities. The complex cases will undoubtedly make the surgeries more difficult, and make endothelial cells density lower after surgeries. It is the most important that a suitable surgical procedure and the indications were selected on the basis of the patients＇ clinical characteristics. Adoption of some modified EK techniques can reduce postoperative endothelial cell loss, which can improve the successful rate of surgeries.