穿透性角膜移植术后角膜内皮细胞的动态变化

Dynamic change of endothelial cell density after penetrating keratoplasty

目的 研究穿透性角膜移植术 (penetratingkeratoplasty ,PKP)后内皮细胞的动态变化 ,探讨内皮细胞的变化规律及其影响因素。方法 穿透性角膜移植病例 6 4例 6 6眼 ,于术前对供体角膜行内皮细胞检查 ,术后密切观察并定期在术后 1、3、6、12、18、2 4、36个月角膜病专科门诊随访。除常规检查外 ,重点记录内皮细胞的变化情况 ,对内皮细胞数进行统计学分析。结果 本组穿透性角膜移植手术后植片内皮细胞数量变化为 :术前平均内皮细胞数为 (2 982± 4 4 9)cell/mm2 ,术后 3、6、12、18、2 4、36个月平均内皮细胞数分别为 (2 5 6 3± 373)cells/mm2 、(2 2 4 0± 371)cells/mm2 、(2 0 16± 4 2 7)cells/mm2 、(184 2± 4 86 )cells/mm2 、(1711±5 5 8)cells/mm2 、16 86cells/mm2 。术后 3个月比术前减少了 14 0 5 % ,术后 1年比术前减少了 32 39% ,术后 2年比术后 1年减少了10 2 1% ;2年较术前共减少了 4 2 6 %。术后 3～ 6个月每月平均下降 4 19% ,术后 6～ 12个月每月平均下降 1 6 7% ,术后 12～ 18个月每月平均下降 1 4 3% ,术后 18～ 2 4个月每月平均下降 1 18% ,2 4个月后仍有下降 ,但下降速度更缓。结论 穿透性角膜移植术后 3年内皮细胞数量一直呈下降趋势 ,以术后半年内下降幅度最大 ,随时?

Objective To study the dynamic variety regulation of endothelial cell density and the related influence factors after penetrating cornea transplantation(penetrating keratoplasty,PKP).Methods The author had checked donor corneas endothelial cell preopreation and followed up sixty six corneal disease blind patients undergone PKP on months 1,3,6,12,18,24 and 36. Statistical analysis was performed besides regular examination.Results The change of mean endothelial cell density was (2 982±449)cells/mm 2 preoperation,(2 563±373)cells/mm 2,(2 240±371)cells/mm 2,(2 016±427)cells/mm 2,(1 842±486)cells/mm 2,(1 711±558)cells/mm 2,1686cells/mm 2 on months 3,6,12,18,24,36 after operation.The mean endothelial cell density descended 14 05% in 3 month after PKP compared with preoperation,32 39% in the first year compared with preoperation,10 21% in the second year compared with the first year.The cell loss in all was 42 62% in two years after keratoplasty compared with the preoperation.But the cell density descended on average 4 19% from 3 to 6 month,1 67% from 6 to 12 month,1 43% from 12 to 18 month,1 18% from 18 to 24 month after keratoplasty,respectively.After 24 month endothelial cell density still descended,but the range was smaller than that before.Conclusion Endothelial cell density always declined in three years after PKP,especially within 6 months.The rate of descent slowed with the lapse of time.