缝线辅助角膜内皮移植在有晶状体眼手术疗效分析

Phakic Descemet stripping automated endothelial keratoplasty in Asian eyes： outcomes and complications

目的研究对有品状体眼患者进行缝线辅助角膜内皮移植手术的效果及并发症。方法回顾性系列病例研究。对2008年8月至2011年8月于北京大学第三医院进行有晶状体眼角膜内皮移植术的病例资料进行回顾性分析，记录患者角膜疾病及合并的眼部疾病情况，包括术前及术后12个月时远视力、近视力、眼压、中央前房深度、角膜厚度、角膜内皮细胞计数及手术并发症，所有患者随访12个月以上。结果共16例患者21只眼纳人研究，男性11例，女性5例，年龄2—47岁，诊断包括各种类型角膜内皮营养不良7只眼，大泡性角膜病变14只眼。患者术前远、近视力（LogMAR）分刖为1．7±0．7、1．2±0．4，术后12个月时，远、近视力分别为0．8±0．6、0．7±0．5，Z值分别为-3．517，-2．764，分别为P〈0．001（P=0．006）。术前眼压为（15．8±3．7）mmHg，术后眼压为（15．2±2．6）mmHg，Z=-0．505，P=0．614。术前前房深度为（3．00±0．74）mm，术后前房深度为（2．72±0．59）mm，Z=-0．524，P=0．600。供体内皮细胞计数为（2992±163）cells／mm^2，术后12个月时内皮细胞计数为（1836±412）cells／mm^2，内皮细胞损失率约为39％？术后12个月时手术成功率为86％。手术歼发症包括术后高眼压5只眼（24％），植片脱位3只眼（14％），植片偏位1只眼（5％）。结论有晶状体眼角膜内皮移植术通过保留自身品状体可以显著提高患者远视力及近视力，保留患者的调节功能，对于需要保留晶状体的患者是一种可选择的手术术式，术后需要重点防范瞳孔阻滞性高眼压。

Objective To investigate the outcomes and complications of suture pull-through inser-tion techniques for Descemet stripping automated endothelial keratoplasty （DSAEK） in Chinese pha-kic eyes. Methods Retrospective case series. Included in the study were all Chinese patients with phakic eyes who underwent DSAEK at Peking University Third Hospital from August 2008 to Au-gust 2011. All ocular diseases of the patients were recorded. Distance visual acuity （DVA）, near visu-al acuity （NVA）, intraocular pressure （IOP）, anterior chamber depth （ACD）, central corneal thickness （CCT）, and corneal endothelial cell density （ECD） were compared prior to and 12 months after DSAEK. The DSAEK success rate, endothelial cell loss （ECL）, complications, and prognosis were an-alyzed. All patients had at least 12 months of follow up. Results Twenty-one eyes of 16 patients were included （11 males and 5 females）. Ages ranged from 2 to 47 years with an average age of 29.8 years. The average follow up was 15.4 months （ranging from 12 to 36 months）. Diagnoses in-cluded 7 eyes （4 patients） with corneal endothelial dystrophy and 14 eyes （12 patients） with bullous keratopathy. Pre-surgical DVA and NVA （LogMAR） were 1.7 ± 0.7 and 1.2 ± 0.4; postsurgical DVA and NVA were 0.8±0.6 and 0.7±0.5; Z =-3.517, -2.764; P 〈0.001 and P =0.006 respectively. Pre-sur-gical IOP was 15.8±3.7 mmHg; postsurgical lOP was 15.2±2.6 mmHg; Z =-0.505, P =0.614. Pre-sur-gical ACD was 3.00±0.74 mm; postsurgical ACD was 2.72±0.59 mm; Z =-0.524, P =0.600. Donor ECD were 2992±163 cells/mm^2, ECD were 1836±412 cells/mm^2 with a 12-month postsurgical ECL of 39%. Success rate was 86%. Surgery complications included pupillary block-induced hypertension in 5 eyes （24%）, graft detachment in 3 eyes （14%）, and graft dislocation in 1 eye （5%）. Conclu-sions DSAEK on Chinese phakic eyes can significantly improve DVA and NVA by preserving the patient＇s own crystalline lens. DSAEK is an optional surgery for patients who need to preserve ac-commodative function. More attention should be given to postsurgical pupillary block-induced hyper-tension.