甘油保存角膜材料行深板层角膜移植术后临床和共焦显微镜观察

Clinical and confocal microscopic observations of deep anterior lamellar keratoplasty with glycerin cryopre-served corneal tissue

目的 观察甘油保存角膜材料行深板层角膜移植术后临床和共焦显微镜活体组织学改变.方法 2008年1月至2011年5月在我院行深板层角膜移植治疗的患者26例（26只眼）,所有患者植片均选择甘油脱水低温保存角膜材料,术后裂隙灯观察角膜植片愈合和透明情况,Cochet-Bonnet角膜知觉计测量角膜中央知觉值,共焦显微镜观察角膜全层组织的活体改变.结果 （1）裂隙灯观察26例患者均于术后1~3个月上皮完全修复,角膜植片透明,术后2例发生基质排异反应.（2）术后3个月可不同程度检测到角膜中央知觉,术后3个月角膜中央知觉平均阈值（18.35±9.56）mm,12个月（51.62±6.48）mm.（3）共焦显微镜观察术后1~3个月上皮细胞密度达正常值,3个月内未观察到角膜基质细胞,6~12个月基质细胞密度增加,术后6个月可观察到基质内神经干细胞,角膜内皮细胞密度维持稳定,但在两例发生基质排异反应患者出现内皮细胞密度明显下降.结论共焦显微镜在组织学上证明甘油保存角膜材料行深板层角膜移植后可在一定程度上恢复正常生理结构,并与临床观察角膜愈合过程相吻合.

Objective To observe clinical and microstracture changes of corneal tissue after deep lamellur kerato- plasty with glycerin cryopreserved cornea. Methods We reviewed 26 patients （26 eyes ） who received deep lamellar kera- toplasty （DLKP） with glycerin cryopreserved corneal tissue between January 2008 and May 2011 in our hospitaL Clinical changes of cornea were observed with slit-lamp and Cochet-Bonnet esthesiometer. Microstructure changes were examined with in vivo confocal microscopy. Results （ 1 ） Corneal epithelium in all patients were completely restored in 1 ~ 3 months. Corneas were transparent. Stromal rejection happened in 2 cases. （ 2 ） Central cornea sensation was detected in 3 months, and average threshold was 18.35 ± 9.56 mm at 3 months and improved to 51.62 ± 6.48 mm at 12 months. （3）Observations with confocal microscopy demonstrated the nonnalization of epithelium density in 1 ~ 3 months. Stromal kemtocytes were not be observed at 3 months, but in 6 ~ 12 months there was an increase in keratocytes density. Regeneration of stromal nerve fibers was observed since 6 months. Endothelial density remained stable exeept＇that in 2 cases with stromal rejection, it decreased significantly. Conclusion Deep anterior lamellar keratoplasty with glycerin cryopreserved corneal tissue can promote recovery of normal physiological functions of the cornea, as evidenced by clinical and microstructural observations