保留段氏层角膜内皮移植术治疗角膜内皮失代偿的早期临床观察

Early clinical observation of corneal endothelial transplantation with retained Dua’s layer in the treatment of corneal endothelial decompensation

目的探讨保留段氏层角膜内皮移植术治疗角膜内皮失代偿的安全性、有效性。方法回顾性病例系列研究,收集宁波市眼科医院2013年11月至2017年6月,19例20眼行保留段氏层角膜内皮移植术,用虹膜恢复器呈螺旋形钝性机械分离,分离至段氏层后剥离角膜基质,徒手制作保留段氏层角膜内皮植片,人工晶体植入器将内皮植入前房后,注入无菌空气展开、固定植片,术后平躺4小时。结果徒手制作角膜内皮植片植片成功率19/20,角膜内皮植片脱位6例,再次注气复位全部成功,术后高眼压5例,4例高眼压经放出前房气体,眼压控制,1例ICE术后高眼压,经睫状体光凝控制眼压。术后最佳矫正视力为0.1~0.8,平均视力(0.24±0.17),术前最佳矫正视力与术后最佳矫正视力二者差异有统计学意义(t=-6.023,P<0.001),术后角膜厚度为(600±91.27)mm,术后角膜内皮细胞密度为(1570±130.45)个/mm^2。结论保留段氏层角膜内皮移植术,器材简单,手术成功率高,术后视力明显提高。

Objetive to investigate the safety and efficacy of corneal endothelial transplantation with retained Dua’s Layer in the treatment of corneal endothelial decompensation.Methods from November 2013 to June 2017,19 patients(20 eyes)with corneal endothelial transplantation with retained Dua’s Layer were collected from a series of retrospective case studies.The corneal stroma was removed and corneal endothelium grafts were made by hand.After implantation of endothelium into anterior chamber,intraocular lens implants were injected into aseptic air to expand the corneal stroma,and the grafts were fixed and lay flat for 4 hours after operation.Results the success rate of hand-made corneal endothelium grafts was 19/20.6 cases of corneal endothelial graft dislocation were successfully retreated.5 cases had high intraocular pressure(IOP),4 cases had intraocular pressure(IOP)control.Intraocular pressure(IOP)was controlled by ciliary body photocoagulation in 1 case after ICE.The postoperative best corrected visual acuity(BCVA)was 0.1~0.8,the average visual acuity was(0.24±0.17).There was a significant difference between preoperative BCVA and postoperative BCVA(t=-6.023,P<0.001).The corneal thickness was(600±91.27)mm,and the corneal endothelial cell density was(1570±130.45)/mm^2.Conclusion Corneal endothelial transplantation with retained Dua’s Layer had advantages of simple equipment,high surgical success rate,significantly improved postoperative visual acuity.