不剥除后弹力膜内皮移植术治疗人工晶状体植入术后的大泡性角膜病变观察

Preliminary clinical study of non-Descemet stripping endothelial keratoplasty for bullous keratopathy

目的评价不剥除后弹力膜的内皮移植术治疗人工晶状体植入术后大泡性角膜病变的临床疗效。方法对2013年6月至2014年10月在深圳市眼科医院就诊的7例（7只眼）人工晶状体植入术后大泡性角膜病变患者，施行不剥除后弹力膜的内皮移植术，随访6～12个月，平均8．1个月，观察术后视力变化、内皮密度数及植片与植床愈合情况。结果术后眼红痛、异物感等临床症状明显缓解或消失，术后3个月最佳矫正视力提高范围0．05-0．5，术后6个月平均角膜内皮细胞密度为（2168±525）cells/mm^2，发生植片移位2例，经手术复位后恢复良好，其中1例因植片移位接触房角引起继发性青光眼。随访12个月，7例植片保持透明，未发生排斥反应、未见人工晶状体脱位。结论不剥除后弹力膜的内皮移植术治疗人工晶状体植入术后的大泡性角膜病变效果良好，但远期疗效尚需继续随访。

Objective To investigate the clinical effect of non-Descemet stripping endothelial ker- atoplasty for builous keratopathy. Methods Seven patients （7 eyes） with bullous keratopathy by intra- ocular lens at Shenzhen Eye Hospital from February 2013 to October 2014 underwent non-Descemet stripping endothelial keratoplasty. All patients were followed up for 6-12 months. Pre-and postopera- tive best corrected visual acuity （BCVA） were compared, the adherence of the donor disc to the re- cipient endothelium and postoperative donor disc dislocation were monitored during the follow up pe- riod. Graft clearance and endothelial cell density （ECD） were also observed. Results All 7 cases had a clear graft at 1 year postoperatively and all clinical symptoms relieved or disappeared. Postop- eratively BCVA 0.05-0.5 after 3 months, the average and standard deviations of ECD （cells/mm^2） af- ter 6 months were 2168±525. Five donor disc were well adhered to the recipient endothelium. Two case graft dislocation 1 day postoperatively, this patients had good recovery after operation, one case of secondary glaucoma. Conclusions Non-Deseemet stripping endothelial keratoplasty for bullo- as keratopathy produce excellent clinical outcomes, such technically easy and good visual acuity. However, the long-term effects need to be followed up.