不剥除后弹力层的角膜内皮移植术治疗虹膜角膜内皮综合征的角膜失代偿

Non-Descemet stripping endothelial keratoplasty for treating iridocorneal endothelial syndrome in phakic eyes

目的探讨不剥除后弹力层的角膜内皮移植术治疗虹膜角膜内皮综合征的角膜失代偿的可行性和临床疗效。方法回顾性非对照性系列病例研究。选择2008年1月至2009年12月在厦门大学附属厦门眼科中心住院的虹膜角膜内皮综合征的角膜失代偿7例患者，进行不剥除后弹力层的角膜内皮移植术。术后随访3—12个月，应用裂隙灯显微镜、前节相干光断层成像术、超声活体显微镜和激光共焦角膜显微镜观察植片透明度及植片贴附和植片移位等情况，应用角膜内皮细胞分析仪测量角膜内皮细胞密度，并对比手术前后的视力。结果术后无1例免疫排斥反应、植片移位及晶状体损伤发生。3例患者术后第2天出现继发性青光眼，给予20％甘露醇静脉滴注，3例术后第3天随前房空气的逐渐吸收而眼压下降。1例术后高眼压控制不佳，在术后2周行睫状体光凝术后眼压控制正常。7例患者植片均透明，激光共焦角膜显微镜显示术后供受体界面、供体角膜基质的高反光性随着时间明显下降，前节光学相干断层成像术及超声生物显微镜显示角膜内皮植片与受体内皮面贴附良好且虹膜及角膜内皮粘连分离。6例患者术后最佳矫正视力均有不同程度的提高；1例患者术后视力不提高的原因为青光眼性视神经萎缩。术后平均角膜内皮细胞密度为（2176．6±267．6）个／mm^2。结论不剥除后弹力层的角膜内皮移植术治疗虹膜角膜内皮综合征的角膜失代偿具有安全、有效、操作简便等特点，有望成为治疗该病的手术方式之一。

Objective To investigate the feasibility and clinical effects of non-Descemet stripping endothelial keratoplasty （nDSEK） on treating iridocorneal endothelial （ICE） syndrome in phakic eyes. Methods Retrospective noncomparative interventional case series. 7 patients （7 eyes） with ICE syndrome at the Affiliated Xiamen Eye Center of Xiamen University from January 2008 to December 2009 underwent non-Descemet stripping endothelial keratoplasty. All patients were followed up for 3-12 months, pre- and postoperative best corrected visual acuity （BCVA） were compared, the adherence of the donor disc to the recipient endothelium and postoperative donor disc dislocation were monitored during the follow-up period. Graft clearance and endothelial cell density（ECD） were observed, too. Results After nDSEK, no primary graft failures dislocation and decentered graft occurred during the follow-up period. Study group intraoperative complications included 3 case with elevated intraocular pressure 2 day postoperatively. Subepithelial haze, donor-recipient interface haze, and interface particles were observed in all measurable cases by in vivo laser confocal microscopy. Anteriorsegment optical coherence tomography and ultrasound biomieroscopy showed the adherence of the donor disc to the recipient endothelium and peripheral anterior synechiae were separated. All corneas remained clear during the follow-up. 6 patients had improved BCVA while 1 patient bad the same BCVA. The reason for poor VA was optic atrophy due to glaucoma. Postoperative mean EDC was （2176. 6 ± 267. 6 ） cells/mm^2. Conclusions nDSEK for iridocorneal endothelial（ICE） syndrome is feasible, technically easy, safe and effective. It can be one of the surgical treatment option for bullous keratopathy.