穿透性角膜移植术后移植片内皮细胞远期形态学观察

Long-term study on endothelial morphology of corneal grafts after penetrating keratoplasty

目的 :分析穿透性角膜移植术 (PK)后透明植片内皮细胞远期的形态学变化和与植片寿命的关系。同时调查穿透性角膜移植术后 2 3年间白内障、青光眼、角膜排斥反应、植片失活的机率。方法 :应用非接触内皮显微镜和图像分析技术对 14 8名单眼PK手术患者移植片和手术眼角膜进行活体内皮细胞形态定量分析。结果 :1 术后 3月～ 10年 ,植片内皮细胞数量下降迅速 ,达到 72 5± 17 7% (M±SD) (r =13 % ) ;细胞面积、形态系数、细胞周长和非六角形细胞比率增大P <0 0 1,而六角形细胞比率和细胞形态系数变小P <0 0 0 6。 2 术后 10～ 2 3年 ,植片内皮细胞丢失速度减慢 (r =3 % ) ,同时细胞面积的变异系数变得相对稳定 (2 7 8% )P <0 0 1。六角形细胞比率和细胞形系数逐渐恢复到正常水平P <0 0 5。 3 PK术后白内障手术率 14 % ,青光眼和排斥反应的发病率是 16%和 2 9%。 4 PK术后植片失活率是18%。晚期植片内皮功能衰竭是晚期植片失活的主要原因 ,术后 5～ 2 3年 12例植片失活患者中发生了 7例。结论 :1 PK术后 11～ 2 3年 ,每年内皮细胞密度稳定下降。六角形细胞比率和细胞形状系数恢复正常 ,面积变异系数稳定说明内皮细胞层稳定性得以恢复。细胞密度和细胞形态在评估PK术后的愈合过程是同样重要。 2 PK术?

To study the long-term morphological changes in endothelium of clear corneal grafts after penetrating keratoplasty (PK),the relationship of the morphological changes with the lifespan of grafts,and the frequency of cataract,glaucoma,graft rejection and graft failure.Follow-up was 23 years. Methods:Using endothelium microscopy and computerized digitizer,the corneal endothelial morphologies of 148 grafts and corneas from single-eye PK patients were analyzed. Results:Within the first 10 years after PK,endothelial cell lost rapidly (72 5±17 7%,r=13%) The coefficients of variation of cell area,the cell area,cell perimeters and the percentage of non-hexagonal cells increased (P<0 01),while the percentage of hexagonal cells and cell figure coefficient decreased (P<0 006).Then cell loss occurred at a considerably slower rate (r=3%) and the coefficient of variation of cell area kept relatively constant (27 8%,P<0 01),the percentage of hexagonal cells and figure coefficient returned gradually to normal value (P<0 05).The frequencies of subsequent cataract surgery were 14%.Glaucoma and graft rejection were 16% and 29%,respectively.The rate of graft failure was 18%.Endothelial failure became the major cause of graft failure,accounting for 7 of the 12 failure cases during 5 to 23 years after operation. Conclusions:The outcomes suggest the re-establishment of stability of endothelial structure has completed within 11 to 23 years after PK.The roles of endothelial cell density and endothelial morphometry on the assessment of endothelial healing after PK are equally important.Subsequent cataract surgery,glaucoma and the rejection after PK might increase the rate of endothelial de-compensation of graft.