角膜表面镜片术后同一植片行深板层角膜移植术治疗急性圆锥角膜水肿

Deep anterior lamellar keratoplasty using the same graft after epikeratophakia for the treatment of acute corneal hydrops in keratoconus

目的探讨角膜表面镜片术后同一植片行深板层角膜移植术治疗急性圆锥角膜水肿的临床效果。方法回顾性分析我院急性圆锥角膜水肿病例7例（7只眼）。采用同一供体角膜植片，一期行表面角膜镜片术联合前房内C3F8注气术；二期行深板层角膜移植术（DALK）联合前房内空气注入术。随访内容为：最佳矫正视力、角膜前后表面愈合情况、眼前段光学相干断层扫描（AS—OCT）分析、角膜内皮细胞密度（CD）等。结果一期角膜表面镜片术后受体中央植床厚度在术前、术后1d、7d、1个月、6个月分别为（1764±256）μm、（778±147）μm、（604±23）μm、（579±20）μm、（525±19）μm。一期术后（6．1±1．3）个月，行二期DALK术中3例可完全暴露角膜后弹力层，4例在接近后弹力层时发生渗液，所有病例均可顺利完成手术。二期术后1d，有2例发生双前房现象，二期术后7d、1个月、3个月，整体中央角膜厚度分别为（781±57）μm、（581±49）μm、（521±19）μm，术后3个月中央区受体植床厚度平均为（21±11）μm，二期术后3个月矫正视力（LogMAR）为0．11±0．03。结论角膜表面镜片术后同一植片行深板层角膜移植术治疗急性圆锥角膜水肿的临床效果确切。

Objective To evaluate the clinical effects of deep anterior lamellar keratoplasty （DALK） using the same graft after epikeratophakia for the treatment of acute corneal hydrops in keratoconus. Methods A consecutive 7 cases （7 eyes） with acute corneal hydrops in keratoconus in our department were retrospectively analyzed. Same corneal graft was used to perform the first stage epikeratophakia combined with C3Fs anterior chamber injection. About 6 months after the first surgery, the secondary stage deep anterior lamellar keratoplasty combined with air anterior chamber injection was performed. The best corrected visual acuity, healing status of the anterior and posterior corneal surface, anterior segment optical coherence tomography parameters, and corneal endothelial cells density were recorded. Results The central corneal thickness was （1764 ±256） μm before the treatment, and it was （778 ±147） μm, （604 ±23） μm, （579 ±20） μm and （525±19） μm at the time points of 1 d, 7 d, 1 and 6 months after the first stage surgery respectively. An average （6.1 ± 1.3 ） months after the first stage surgery, the second stage DALK was performed. The descemet＇ s membrane at the central area could be fully exposed in 3 eyes. Slow liquid exudations in the deep corneal stroma near the descemet＇ s membrane were found in the other 4 eyes during stroma dissection. DALKs were successfully performed in all the 7 cases. Double anterior chambers were found in 2 eyes ld after DALK. The whole corneal thicknesses were （781 ± 57） μm, （581 ±49）μm and （521 ± 19） μm at 7 d, 1 and 3 months after DALK respectively. Three months later, the thickness of the receptors＇ residual stroma bed was （21 ± 11 ） μm at the central corneal area. At the end of the follow-up, the BCVA （LogMAR） was 0. 11 ± 0.03. Conclusion Novel curative effect was found in the treatment of acute corneal hydrops in keratoconus by deep anterior lamellar keratoplasty using the same graft after epikeratophakia.