角膜深板层内皮移植术的临床初步研究

Microkeratome-assisted deep lamellar endothelial keratoplasty

目的 探讨用微型角膜刀行角膜深板层内皮移植术的适应证、手术原则、临床疗效及并发症的预防及处理。方法 用微型角膜刀对 6例患者 6只患有大疱性角膜病变眼行深板层角膜内皮移植术。其中 1例为前段玻璃体切除加后房型人工晶状体缝线固定术联合角膜深板层内皮移植术 ,1例为临时人工角膜下玻璃体切除加球内异物取出术联合角膜深板层内皮移植术。术后随访 6～ 9个月。结果 5例患者视力明显提高 ,患者术后平均角膜内皮细胞密度为 (2 4 81± 2 12 )个 /mm2 ,角膜中央厚度平均为 (5 4 9± 6 1) μm ,散光为 (2 0 4± 1 19)D ,未发生严重并发症。 结论 用微型角膜刀行角膜深板层内皮移植术是治疗大疱性角膜病变的可选术式。与传统的穿透性角膜移植相比 ,该术式有望成为角膜内皮移植的技术平台 ,但远期疗效尚需继续随访。

Objective To observe the indication, surgical principle, clinical results and complications of microkeratome-assisted deep lamellar endothelial keratoplasty (DLEK). Methods DLEK was performed in six patients with bullous keratopathy. One of the six patients underwent DLEK combined with vitrectomy under temporary artificial corneal and intraocular foreign-body removal. Another underwent DLEK combined with vitrectomy and posterior chamber intraocular lens implantation. The patients were followed up for 6～9 months. Results The postoperative best-corrected visual acuity showed clear improvement in 5 cases. Endothelial cell density averaged (2481±212) cells/mm 2 . Pachymetry averaged (549±61) μm. Astigmatism averaged (2.04±1.19)D. No serious complication was found. Conclusion DLEK is an alternative choice for PKP. It may offer further advantages over conventional PKP surgery, and could serve as a surgical technique in endothelial keratoplasty. A long-term follow-up in a larger patient population is needed to confirm our initial results.