自动角膜板层刀切割一个供体角膜用于两位患者

Single corneal donor tissue specimen split by microkeratome for two recipients

目的评估应用自动角膜板层刀切割一个供体角膜用于深板层角膜移植和角膜内皮移植的临床疗效及安全性。方法回顾性系列病例研究。应用自动角膜板层刀预先将新鲜供体角膜进行切割，将带部分基质的角膜内皮植片用于角膜内皮移植术，剩余前板层用于深板层角膜移植术。回顾性分析2010年3—8月期间在温州医学院附属眼视光医院行角膜内皮移植术的17例患者及分别来自同一供体角膜的行深板层角膜移植的17例患者。术后随访19～24个月，分别观察角膜内皮贴附情况及前板层角膜植片愈合情况。随访资料包括医学验光、前节光学相干断层扫描及角膜内皮细胞计数。手术前后视力比较采用配对t检验。结果17例角膜内皮移植患者术后角膜内皮植片均贴附良好，术后视力较术前均有提高。除1例碱烧伤患者因晶状体混浊，无法验光外，其余术后平均散光为（1．69±0．60）D。17例角膜内皮移植患者平均角膜内皮细胞计数为（2128±244）个／mm^2，平均角膜内皮植片厚度为（152±46）μm。17例前板层角膜移植患者角膜植片均透明，术后最佳矫正视力较术前提高，平均散光为（2．50±0．90）D；平均前板层角膜植片厚度为（343±39）μm。结论利用角膜板层刀将一个供体角膜用于两位患者的方法在临床实际应用中切实可行。经长期随访，角膜植片未出现明显并发症。该方法可以更充分地利用供体角膜，缓解中国供体角膜匮乏现状，意义重大。

Objective To evaluate the safety and the clinical effects of a single corneal tissue donor specimen split by microkeratome and used for deep anterior lamellar keratoplasty and endothelial keratoplasty. Methods It was a retrospective case series study. Fresh donor corneas were split by microkeratome （Amadeus II, Switzerland）. The endothelial graft with a small section of the stroma was used for endothelial keratoplasty （EK）, and the anterior lamellar button was used for deep anterior lamellar keratoplasty （DALK）. Clinical data of 17 consecutive patients who underwent EK from March 2010 to August 2010 and 17 patients who underwent DALK whose donor grafts were matches for the endothelial grafts were reviewed. The attachment of the endothelial grafts and postoperative restitution of the anterior lamellar buttons were evaluated during the 19-24 month follow-up period. Optometric examinations, optical coherence tomography for all patients, and an endothelial cell count for patients who underwent EK were performed. Pre- and postoperative visual acuity analyzed using paired t test. Results The endothelial grafts of the 17 patients who underwent EK had attached well and postoperative visual acuity was improved. The mean astigmatism of the patients was 1.69±0.60 D with the exception of one alkali-burn patient whose optometric data was not available because of corneal opacity. The mean density of endothelial cells for the 17 patients who underwent EK was 2128±244 cells/mm^2 and the mean thickness of the endothelial grafts was 152±46μm. Anterior lamellar buttons of the 17 patients who underwent DALK were transparent and postoperative best corrected visual acuity improved as well. The mean astigmatism was 2.50±0.90 D and the mean thickness of the anterior lamellar buttons was 343±39 μm. Conclusion The method of splitting a single donor cornea by microkeratome for two recipients is feasible in clinical applications. There were no serious complications caused by donor grafts during the long-term follow-up period. This method, which could make full use of donor corneas and alleviate the cun＇ent shortage of donor corneas is of great significance.