暴露后弹力层的前部深板层角膜移植手术进展

Surgical progress in deep anterior lamellar keratoplasty with baring of Descemet＇s membrane

前部深板层角膜移植术（deep anterior lamellar keratoplasty,DALK）是一种新的角膜移植技术,该技术将去除后弹力层和内皮层的供体角膜移植到去除全部基质的植床上,以期望获得与穿透角膜移植术相同的光学效果,同时减少术中和术后并发症.DALK对手术技术要求高,关键步骤是暴露后弹力层.暴露后弹力层的方法经历了直接分离法、基质无菌空气辅助分离法、水分离法、黏弹剂法、大泡技术等,这些技术在不断改进且日趋成熟.DALK的优点是保留了眼球结构和免疫的相对完整性,可减少术后内皮型免疫排斥反应、角膜植片慢性功能失代偿以及角膜植片因外伤哆开的风险.本文就DALK的适应证、手术技术和并发症等进行综述,为其技术改进和广泛临床应用提供思路.

Deep anterior lamellar keratoplasty （DALK） is a new keratoplasty technique,which transplants a partial thickness donor cornea bared of its Descemet＇s membrane and endothelium onto a recipient bed after full removal of recipient stromal tissue,in order to provide similar visual outcome with penetrating keratoplasty as well as to decrease intraoperative and postoperative complications.This surgical procedure is technically challenging and the critical step is to bare Descemet＇s membrane.The ways to bare Descemet＇s membrane have experienced direct open dissection,intrastromal air injection dissection,hydrodelamination dissection,viscoelastic dissection,big bubble technique,etc..These techniques are being constantly improved to perfect.The advantage of DALK is that it relatively preserves both structural and immunological integrity of the eye,thus decreasing the risk of endothelial graft rejection,chronic corneal allograft dysfunction and traumatic wound dehiscence.This review focuses on the indications,different techniques and complications of DALK,aiming at providing ways to promote its technological improvement and widely clinical application.