飞秒激光角膜内皮移植治疗角膜内皮失代偿效果分析

Preliminary results of femtosecond laser-assisted Descemet stripping endothelial keratoplasty for bullous keratopathy

目的探讨飞秒激光角膜后弹力层剥除角膜内皮移植治疗角膜内皮失代偿的可行性及效果。方法前瞻性选择白内障手术后角膜内皮失代偿病例，给予角膜后弹力层剥除角膜内皮移植术，用Intralase150飞秒激光制作供体角膜内皮植片，供体为中期保存角膜植片。共选择2013年9月至12月7例患者。术中剥除患眼角膜中央部直径7．75mm的后弹力层和病变的内皮层，常规角膜内皮移植术的方法植入内皮植片，同时10．0缝线1针固定植片于透明角膜。术后观察植片与植床贴合和植片移位等情况。随访12个月，记录患者视力、眼压、植片透明度、术眼屈光状态及内皮细胞密度等，计量资料均数±标准差进行统计描述。结果5例患者术后内皮植片和角膜植床贴附良好，2例患者术后第2天植片和植床存在间隙，给予前房注气后，植片和植床贴附良好，术后12个月，未发现植片脱位和移位病例。术后12个月术眼最佳矫正视力为0．04—0．7，平均角膜内皮细胞数为（1698．0±251．8）个／mm^2，平均平均内皮植片厚度为（124．2±11．4）μm，眼压平均为（17．4±2．8）mmHg（1mmHg=0．133kPa）。其中1例患者术后3个月开始植片失去活性，再次出现角膜上皮大泡，给予穿透性角膜移植。结论飞秒激光角膜后弹力层剥除角膜内皮移植治疗角膜内皮失代偿安全有效，可以精确制作内皮植片，具有广泛应用前景，缝线固定内皮植片可有效防止植片移位和脱落。

Objective To evaluate the preliminary results of femtosecond laser-assisted Descemet stripping endothelial keratoplasty （FS-DSEK） for the treatment of bullous keratopathy. Methods In the nonrandomized, prospective, consecutive case series, 7 eyes with bullous keratopathy induced by cataract surgery received FS-DSEK surgery between September and December 2013. Standard Descemet stripping endothelial keratoplasty procedure was performed. The Descemet membrane and abnormal endothelial layer were stripped from the central recipient posterior surface in a diameter of 7.75 mm. The graft was fixed to the edge of recipient cornea with one single stitch. The donor lenticule was produced by lntralase 150 femtosecond laser with a diameter of 7.75 mm. The adherence of donor lenticule to the recipient posterior stroma and postoperative donor lenticule dislocation were monitored in the early stage after surgery. Best spectacle-corrected visual acuity, refraction, endothelial cell density and thickness of grafts were measured preoperatively, and at 1 week, 1, 3, 6 and 12 months after FS-DSEK. Results Two eyes had graft dislocation, with a gap between the graft and recipent posterior stroma at 2 days after surgery. The grafts were repositioned after bubbles were added into the anterior chamber. All grafts were well adherent to the recipent posterior stromal surface at 1 week postoperatively. One graft failed at 3 months postoperatively, and penetrating keratoplasty was performed. At 12 months, the best spectacle-corrected visual acuity was 0.04 to 0.7, the mean endothelial cell density was （1 698.0 ± 251.8） cells/mm2, and the mean thickness of grafts was （124.2 ± 11.4） μm. Conclusion Femtosecond laser-assisted Descemet stripping endothelial keratoplasty was effective in treating bullous keratopathy. Stitching the graft to the recipent cornea can prevent postoperative graft dislocation effectively. （Chin J Ophthalmol, 2016, 52：180-185）