硅胶干燥保存角膜与甘油保存角膜在深板层角膜移植术中应用的临床观察

Clinical observation of the application of silica gel- and glycerol-preserved cornea in deep lamellar keratoplasty

目的对比硅胶干燥保存与甘油保存角膜供体(DX液保存新鲜角膜>7d)对深板层角膜移植术治疗角膜疾病术后临床恢复的影响。方法回顾性病例研究。收集2016年10月至2017年10月,在山东省眼科医院成功实施深板层角膜移植术的角膜病患者,分为甘油保存30例和硅胶干燥保存30例。采集供体资料,观察记录术后角膜植片水肿程度、角膜透明度、层间积液发生率、上皮愈合时间及视力等。结果(1)两组患者术后角膜植片透明度:术后1d干燥组供体为1.4±0.8,甘油组为2.8±0.7,差异有统计学意义(t=2.468,P<0.05),术后1周干燥组供体为1.3±0.8,甘油组为2.1±0.7,差异有统计学意义(t=2.143,P<0.05)。(2)视力:术前2组视力比较,差异无统计学意义(P>0.05);术后1周2组患者裸眼视力,最佳矫正视力及散光值比较,各数值差异有统计学意义(P<0.05);(3)术后层间积液:干燥组层间积液患者占3%,甘油组占23%,差异有统计学意义。(4)术后植片水肿程度及水肿变化:中央角膜厚度(CCT)干燥组术后1周植片厚度为(614.1±18.7)μm,术后1个月植片厚度为(531.7±16.4)μm,CCT甘油组术后1周植片厚度为(705.5±30.6)μm,术后1个月植片厚度为(618.9±50.5)μm,二者与干燥组比较,差异均有统计学意义;CCT干燥组术后3个月、6个月植片厚度与甘油组术后差异无统计学意义;(5)角膜上皮愈合时间:干燥组为(5.1±1.1)d,甘油组(8.4±2.3)d,差异有统计学意义(t=2.968,P<0.05)。结论干燥保存角膜在术后层间积液发生率、角膜植片水肿及水肿消退速度、角膜上皮愈合时间、早期角膜植片透明度、早期视力等方面明显优于甘油保存角膜,可明显降低角膜移植术后常见的早期并发症的发生,作为角膜非活性保存方法之一可以进一步推广。

Objective To compare the effect of silica gel-and glycerol-preserved donor cornea(DX liquid preservation of fresh cornea for 7 days) on the clinical recovery after deep lamellar keratoplasty for corneal diseases.Methods This was a retrospective case study conducted from October 2016 to October 2017, and patients with corneal diseases who underwent successfully deep lamellar keratoplasty at Shandong Ophthalmic Hospital were enrolled. Study participants were divided into two groups: 30 cases to the glycerol preservation group and 30 cases to the silica gel preservation group. Data of the donor were collected and the degree of postoperative corneal graft edema, corneal transparency, incidence of interlaminar hydrops, epithelial healing time, and visual acuity were assessed and recorded. Results Postoperative transparency of the corneal grafts in the two groups at 1 day after the surgery was 1.4±0.8 in the silica gel group and 2.8±0.7 in the glycerol group, with statistically significant difference(t=2.468,P<0.05). At 1 week after the surgery, the transparency in the above two groups was 1.3±0.8 and 2.1±0.7, respectively with statistically significant difference(t=2.143,P<0.05). There was no significant difference in pre-surgical visual acuity between the two groups(P>0.05). However, there were significant differences between the two groups in uncorrected, best corrected visual acuity and astigmatism at 1 week after the surgery, and the differences were statistically significant(P<0.05). The percentage of patients with interlaminar hydrops in the silica gel group and the glycerol group was 3% and 23%, respectively, and the difference was statistically significant(P<0.05). In consider of postoperative corneal graft edema, the thickness of corneal graft in the silica gel group was(614.1±18.7)μm at 1 week after the surgery and(531.7±16.4)μm at 1 month after the surgery. Corresponding values in the glycerol group was(705.5±30.6)μm and(618.9±50.5)μm,respectively, which were significantly different from the silica gel group. The thickness of corneal graft at 3 and 6 months after the surgery in the glycerol group were not statistically different from the silica gel group. The healing time of corneal epithelium was(5.1±1.1)days in the silica gel group and(8.4±2.3)days in the glycerol group, and the difference was statistically significant(t=2.968,P<0.05). Conclusions The silica gel-preserved cornea was superior to the glycerol-preserved corneal in the following aspects: incidence of postoperative interlaminar hydrops, corneal edema and the speed of edema recovery, corneal epithelial healing time, early postoperative corneal graft transparency and visual acuity. The silica-preserved corneal can significantly reduce the occurrence of common early complications after corneal transplantation, and thus could be broadly used as one of the inactive cornea preservation methods.