甘油冷冻保存角膜深板层角膜移植术治疗圆锥角膜

Deep anterior lamellar keratoplasty using glycerin-cryopreserved corneal tissue for keratoconus

目的分析甘油冷冻保存角膜深板层角膜移植术（DALK）治疗圆锥角膜术后角膜内皮细胞密度及屈光状态变化。方法回顾性病例研究。分析圆锥角膜患者用甘油冷冻保存的角膜材料行DALK治疗的44例（49眼）病例资料，其中17例（17眼）患者于术后1个月、1年、2年、3年、4年按期进行随访，且随访资料完整。分析术后角膜内皮细胞丢失率、视力以及屈光状态。结果患者平均随访时间为（39．0±12．6）个月，无一例发生植片免疫排斥。术前平均内皮细胞密度（ECD）为（2597±578）个／mmz．术后1个月、1年、2年、3年、4年时平均ECD为（1790±409）cells／mm2、（1703±443）cells／mm2，（1632±389）cells／mm2、（1638±357）cells／mm2、（1675±283）cells／mm2、（1611±421）cells／mm2。术后4年ECD较术前减少34．2％。术前平均裸眼视力（UCVA）为（1．40±0．60）logMAR，平均最佳矫正视力（BCVA）（0．98±0．54）logMAR，术后1个月、1年、2年、3年、4年平均BCVA分别为（0．44±0．12）logMAR、（0．36±0．20）logMAR、（0．32±0．23）logMAR、（0．29±0．20）logMAR、（0．27±0．16）logMAR。结论使用甘油冷冻保存的角膜材料的角膜移植术治疗圆锥角膜可获得较好的视力，角膜内皮细胞丢失率低．远期疗效较好。

Objective To evaluate changes in endothelial cell density, visual acuity and refractive outcomes after deep anterior lamellar keratoplasty （DALK） using glycerin-cryopreserved corneal tissue. Methods This was a retrospective case-control study. The clinical data were collected from 44 patients （49 eyes） who had been diagnosed with keratoconus who had undergone DALK with glycerin-cryopreserved corneal tissue at Shandong Eye Institute and Hospital. Among them, 17 patients （17 eyes） were followed up at 1 month, 1 year, 2 years, 3 years, and 4 years. Endothelial cell loss, visual acuity, and refractive status of these 17 eyes were recorded. Data were analyzed using a paired t test. Results The mean follow-up period was 39.0±12.6 months and no graft rejection occurred. The mean endothelial cell density （ECD） was 2597±578 cells/ram2 before surgery, and was 1790±409 cells/mm2, 1703±443 cells/mm2, 1632±389 cells/mm2, 1638±357 cells/mm2, 1675±283 cells/mm2 and 1611±421 cells/ram2 at 1 month, 1 year, 2 years, 3 years, and 4 years postoperatively. Cell density was reduced by 34.2% at 4 years postoperatively compared with the density before surgery. The mean uncorrected visual acuity （UCVA） was 1.40±0.60 logMAR, and best-corrected visual acuity （BCVA） was 0.98±0.54 logMAR. Mean BCVAs at 1 month, 1 year, 2 years, 3 years and 4 years postoperatively were 0.44±0.12 logMAR, 0.36±0.20 logMAR, 0.32±0.23 logMAR, 0.29±0.20 logMAR and 0.27±0.16 logMAR. Conclusion Glycerin-cryopreserved corneal tissue can be safe and effective for deep anterior lamellar keratoplasty to treat keratoconus and provides higher survival rates of the corneal endothelium.