Simultaneous tectonic Descemet stripping endothelial keratoplasty and tectonic Bowman layer transplant for the management of corneal perforation

AIM:To report the outcomes of three cases of corneal perforation managed with simultaneous tectonic Descemet stripping endothelial keratoplasty(t-DSEK)and tectonic Bowman layer transplant(t-BLT)as an alternative to tectonic penetrating keratoplasty(t-PKP).METHODS:Three eyes of three patients receiving simultaneous t-DSEK and t-BLT for corneal perforation were included.The technique for DSEK was modified depending on individual requirements.The t-BLT technique was standardised using an 8 mm graft and fixated with a running suture.Success was measured by the ability of this procedure to close a corneal perforation.RESULTS:All three cases achieved tectonic eye globe restoration and remained stable during the minimum 3-month observation period.Reinterventions were relatively common:2 cases required amniotic membrane transplant for persistent epithelial defects.One case required DSEK rebubbling.One case developed angle closure glaucoma requiring surgical peripheral iridectomy.CONCLUSION:Simultaneous t-DSEK and t-BLT may be a useful strategy for the management of corneal perforation as an alternative management to t-PKP for selected cases.

Combined Descemet stripping automated endothelial keratoplasty and intravitreal dexamethasone implant for concomitant pseudophakic bullous keratopathy and cystoid macular edema

Dear Editor,Endothelial cell density decreases with age and in various ocular conditions,including corneal endotheliitis,uveitis,pseudoexfoliation syndrome,and birth injury(1)The reduction of endothelial cell density is exacerbated over time after intraocular surgery(1)Descemet stripping automated endothelial keratoplasty(DSAEK)is considered the primary procedure for patients with only endothelial dysfunction.

Visual acuity and endothelial cell density with respect to the graft thickness in Descemet's stripping automated endothelial keratoplasty: one year results

AIM: To evaluate the visual acuity and endothelial cell density according to the thickness in Descemet’s stripping automated endothelial keratoplasty(DSAEK)one year after surgery.METHODS: DSAEK patients’ data were reviewed. Thirty seven eyes of 37 patients who underwent DSAEK for pseudophakic bullous keratopathy(PBK) were included in this study. Graft thickness was measured with optical coherence tomography(OCT) 12 mo after DSAEK. Eyes were divided into 3 groups based on the graft thickness:thick(】200 μm), medium-thick(150-200 μm) and thin(【150 μm). Best corrected visual acuity(BCVA),endothelial cells density(ECD) and complications were assessed and comparisons were done between groups.RESULTS: Median thickness of postoperative grafts was 188(range 73-317 μm). There was no significant difference in age, sex, preoperative BCVA, or follow-up period between DSAEK groups. At postoperative 12 mo,mean BCVA was 0.28±0.10 in thick graft group, 0.52±0.08 in medium-thick graft group, and 0.72 ±0.06 in thin graft group. Thin grafts showed better postoperative BCVA as compared with the medium-thick and thick grafts(P =0.001). Thick graft group had 1637.44 ±88.19-mm2,medium thick graft had 1764.50±34.28-mm2 and thin graft group had 1845.30 ±65.62-mm2. Thin graft group had better ECD at 12 mo after surgery(P =0.001).CONCLUSION: Thin grafts after DSAEK ensure better visual rehabilitation. Eyes with thin grafts had significantly lesser loss of ECD compared to eyes withmedium-thick and thick grafts one year after surgery.

Clinical results of non-Descemet stripping endothelial keratoplasty

AIM： To investigate the impact of non-Descemet stripping endothelial keratoplasty（non-DSEK） on graft rejection rate,and its overall procedural effectiveness in patients.METHODS： Non-DSEK was performed on 65 eyes of 64 patients,and the procedural outcomes,including rejection episodes,failure and dislocation of the grafts,best corrected visual acuity（BCVA）,endothelial cell density（ECD）,and other complications,were analyzed retrospectively.RESULTS： Of the 65 eyes,63 recovered from bullous keratopathy with a clear cornea.The mean follow-up time was 26.4mo（range,6-84mo）.The mean BCVA improved from 1.70 log MAR preoperatively to 0.54 log MAR at 3mo,0.46 logM AR at 6mo,and 0.37 logM AR at 1y after surgery.The postoperative donor ECD of the 25 patients who successfully underwent specular microscopic examination was 1918±534 cells/mm^2（range,637 to 3056 cells/mm^2）,and the mean endothelial cell loss was 41.9% at 24 mo postoperatively.One eye developed secondary glaucoma and required regrafting via penetrating keratoplasty（PKP）.Another eye had postoperative graft failure due to rejection at 26 mo.Postoperative graft dislocation occurred in eight eyes.All of the eight dislocated grafts were reattached using air reinjection.CONCLUSION： Immunological graft rejection of the donor graft rarely occurs in non-DSEK.Therefore,non-DSEK is a safe,concise,and effective alternative to restore corneal decompensation when the Descemet membrane is disease-free.

Descemet stripping automated endothelial keratoplasty in phakic eyes:incision modification reducing cataract formation

AIM： To evaluate the efficacy of a technical modification to reduce the incidence of traumatic cataract induced by Descemet stripping automated endothelial keratoplasty（DSAEK） performed in phakic eyes. METHODS： A retrospective cohort study. The records of all patients with a clear crystalline lens and endothelial failure that underwent modified DSAEK at our insitution were reviewed. In this modification, in order to avoid inadvertent touch of the insertion forceps against the exposed crystalline lens while passing across the anterior chamber, the incision sites were shifted from the standard 9 and 3 o＇clock positions, superiorly to the 10 and 2 o＇clock position respectively. Formation of typically traumatic, anterior subcapsular cataract in these patients was compared to that observed in a cohort including all the patients with a clear crystalline lens and endothelial failure that underwent conventional DSAEK at our institution.RESULTS： The study group included 49 eyes following modified DSAEK and the control group included 35 eyes following DSAEK with conventional incision sites. Anterior subcapsular cataract occurring 4 mo or less postoperatively was identified in 2 of 49（4%） eyes in the study group and 7 of 35（20%） eyes in the control group. The rates of traumatic cataract were significantly higher in the control group in comparison to the study group（P=0.03, RR=4.9, 95%CI 1.08-22.1）.CONCLUSION： Traumatic cataract formation following phakic DSAEK may be avoided with a simple modification to the position of the incision sites.

Complications and outcomes of descemet stripping automated endothelial keratoplasty with artisan aphakia intraocular lens implantation

AIM： To evaluate the complications and outcomes of descemet stripping automated endothelial keratoplasty（DSAEK） combined with artisan aphakia intraocular lens（IOL） implantation in severely damaged eyes without capsular support.METHODS： DSAEK combined with artisan iris claw IOL implantation was performed on 29 eyes. All eyes were of abnormal structure due to complications from prior intraocular surgeries and ocular trauma. Ocular complications observed included graft dislocations, high intraocular pressure（IOP）, IOL dislocations, macular edema and hyphema. Best corrected visual acuity（BCVA）, IOP and mean central endothelial cell density（ECD） were recorded.RESULTS： Thirteen eyes had a history of ocular trauma, 10 eyes had an anterior chamber IOL, 16 eyes had prior vitrectomy. The iris was abnormal in 22 cases. Graft dislocation occurred in 5（17.2%） of 29 eyes. IOL dislocation occurred in 2 eyes（6.9%）. High IOP was found in 9 eyes and was controlled with treatment. The preoperative mean BCVA was 20/286. The 6 mo postoperative mean BCVA was 20/42. The average center ECD was 1965.3 cells/mm^2 at 6 mo, and the rate of the donor cell loss was 34.7%.CONCLUSION： DSAEK combined with artisan aphakia IOL implantation is an alternative option for resolving endothelial and lens disorders in aphakic eyes without capsular support. However, it should be performed cautiously for eyes with severe iris defects.

Incidence of cystoid macular edema after Descemet's stripping automated endothelial keratoplasty

AIM： To determine the incidence of cystoid macular edema（CME） after Descemet＇s stripping automated endothelial keratoplasty（DSAEK）.METHODS： This study included all consecutive patients operated in a Spanish tertiary reference hospital over a period of four years. A total of 55 eyes from 47 patients matched the selection criteria. CME was diagnosed clinically at the slit-lamp and confirmed by optical coherence tomography. RESULTS： Six cases of CME were diagnosed postoperatively, which represented an incidence of 11%. Three patients had previously undergone DSAEK alone（7%; 3/41） and the other three, DSAEK combined with phacoemulsification（21%; 3/14）. Five out of six patients with CME responded to standard therapy.CONCLUSION： CME is a possible complication after DSAEK and can be treated with standard therapy. CME appears more frequently when DSAEK is combined with phacoemulsification and posterior chamber（PC） intraocular lens（IOL） implantation. Intraoperative damage to the corneal endothelial cells might play a role in the pathogenesis of CME. As long as the causes remain unclear, we recommend administering prophylaxis when risk factors are present or when combined surgery is planned.

Modified thin manual Descemet stripping endothelial keratoplasty with air-guided, non-pachymetric donor lenticule dissection: outcomes of graft thickness and complication rate

●AIM:To describe a modified technique of donor lenticule dissection for thin manual Descemet stripping endothelial keratoplasty(TM-DSEK).●METHODS:Donor material was soaked in balanced salt solution(BSS)for 30 min,before being mounted on an artificial anterior chamber(AAC).Rather than BSS,the AAC was filled with filtered air,resulting in a visible reflection at the corneal endothelium-air interface.This reflection served as a landmark for the depth of the dissection,facilitating the creation of a thin lenticule with low risk of perforation.Dissection was commenced at a standardized depth of 500 microns,with no initial pachymetry necessary.Totally 29 donor corneas were dissected by a novice TM-DSEK surgeon.Dissection time,central graft thickness at 2 mo and complications were analysed.●RESULTS:Results were similar to other endothelial keratoplasty techniques,despite the cases being performed by a novice DSEK surgeon.Mean dissection time was 7 min(range 6-10).One graft perforation occurred(3.45%),but the air tamponaded the break and enabled dissection to be restarted and completed from a different location.Mean central graft thickness after at least two months follow-up was 106 microns(range 25-170).●CONCLUSION:A problem with manual DSEK is the risk of graft perforation by attempting to dissect too thin a lenticule,or creating a thick graft due to fear of perforating.This modified air-guided technique addresses this problem,and is recommended for surgeons either embarking on the learning curve,or who wish to achieve more consistently thin grafts while reducing perforation rates.

Suturing Technique to Promote Graft Attachment in Challenging Cases of Descemet Stripping Endothelial Keratoplasty

Aims: To describe a technique that uses a transcorneal fixation suture for graft attachment in endothelial keratoplasty in high-risk for graft dislocation eyes. Materials and Methods: Case series included 12 eyes of 12 patients who underwent Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in the presence of high risk for graft dislocation factors. We describe a surgical technique that uses a transcorneal fixation suture to compress the donor graft onto the back surface of the recipient cornea. Outcome measures included intraoperative and postoperative complications, graft attachment and clarity and endothelial cell count at a 12 months follow-up period. Results: No intraoperative complications were noted and 11 grafts remained attached and clear with no suture related complications at a 12-month follow-up period. Partial peripheral graft detachment due to suture related graft folds, accompanied by mild corneal edema was noticed in one patient postoperatively. Reattachment and edema resolution occurred spontaneously after suture removal. The mean endothelial cell loss was 38.21% at 12 months. Conclusions: Temporary transcorneal fixation suture can be helpful in preventing graft detachment in eyes with high risk for graft dislocation.

A Novel Y-Suture Transfixation Technique to Improve Graft Adherence in High-Risk Descemets Stripping Automated Endothelial Keratoplasty

Purpose: To report a novel Y-suture transfixation technique to improve success rate of high-risk Descemets stripping automated endothelial keratoplasties (DSAEK). Design: Retrospective non-comparative case series. Participants: Twenty five high-risk patients undergoing DSAEK at one tertiary care institution. Methods: A retrospective evaluation of consecutively enrolled high-risk DSAEK cases performed by three surgeons at one institution during a 3-year period (2007-2010). Main outcome measures were graft adherence and suture-related complications. Results: Highrisk factors were defined as followed: prior incisional glaucoma surgery (58%), presence of vitreous in the anterior chamber (15%), anterior chamber intraocular lens (8%), graft dislocation (8%), previous DSAEK (8%), and iris trauma/aphakia (3%). Twenty-five high-risk patients underwent DSAEK with Y-suture transfixation. Postoperative follow-up ranged from 3 to 27 months. One patient had dislocation due to hypotony from prior trabeculectomy (4%), requiring repeat DSAEK. Neither primary graft failure nor suture-related complication was observed. Conclusion: The Y-suture transfixation technique is associated with improved success rate of high-risk DSAEK transplant.

Corneal Endothelial Cell Loss in Femtosecond Laser-assisted Descemet＇s Stripping Automated Endothelial Keratoplasty： A 12-month Follow-up Study

Background：Descemet＇s stripping automated endothelial keratoplasty （DSAEK） surgery offers a more standardized approach and reliable method to create corneal grafts with an instrument such as a microkeratome.With the development of Descemet＇s membrane endothelial keratoplasty,an excellent clinical outcome is seen in the treatment of corneal endothelial dysfunctions,which indicates that thinner corneal graft results in better clinical outcome.With the recent development of the femtosecond laser,ultrathin corneal graft preparation has become possible.This study aimed to report corneal graft endothelial cell loss （ECL） in a large series of cases undergoing DSAEK with femtosecond laser-assisted corneal graft preparation within a 12-month period.Methods：This study was designed as a prospective,noncomparative,interventional case series.Totally 126 consecutive eyes with endothelial failure of 120 patients,who had corneal endothelial decompensation and underwent femtosecond-assisted DSAEK using the VisuMax femtosecond laser system,were included in the study.Central endothelial cell density （ECD） was recorded postoperatively at 2 weeks （n =126）,1 month （n =126）,3 months （n =110）,6 months （n =101）,and 12 months （n =71） and then compared with the preoperative eye bank measurements.Pre-and postoperative central ECDs were evaluated using Heidelberg retina tomography-Ⅲ confocal microscopy.ECL was calculated for each postoperative time point.Graft thickness was examined using anterior segment-optical coherence tomography.Results：Mean preoperative cell count was 3383 ± 350 cells/mm^2.Mean postoperative cell counts were 2382 ± 707 cells/mm^2,2179 ± 685 cells/mm^2,2074 ± 688 cells/mm^2,1884 ± 662 cells/mm^2,and 1723 ± 624 cells/mm^2 at 2 weeks,1,3,6,and 12 months,respectively;these represented the ECL of 29.7 ± 19.7%,35.4 ± 19.5%,38.6 ± 19.8%,44.3 ± 18.9%,and 48.9 ± 18.4% at the each corresponding time point.The mean corneal graft thickness after surgery was 142 ± 48 μm,118 ± 41 μm,108 ± 37 μm,100 ± 32 μm,and 99 ± 32 μm at each corresponding study visit,respectively.There was no correlation between corneal graft thickness and corneal ECL （R =0.039）.Conclusions：Corneal ECL remained relatively stable up to 12 months after femtosecond laser-assisted ultrathin DSAEK in a large case series.No correlation between cell loss and corneal graft thickness was found,which indicated that corneal graft preparation by the femtosecond laser was safe.ECL was faster within the first 6 months and relatively stable thereafter.

Ultrathin Descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty:a fellow-eye comparison

Background:To compare the visual outcome and patients’satisfaction after ultrathin Descemet stripping automated endothelial keratoplasty(UT-DSAEK)and Descemet membrane endothelial keratoplasty(DMEK)performed on fellow eyes of the same patients.Methods:In this retrospective study,the records of 18 pseudophakic patients affected by Fuchs endothelial dystrophy who underwent DMEK in one eye and UT-DSAEK in the fellow eye were reviewed.Best corrected visual acuity(BCVA),corneal pachymetry,keratometry,corneal aberrations,photopic and mesopic contrast sensitivity,and endothelial cell counts measured 12 months after surgery in either eye were analyzed and compared.The results of a satisfaction questionnaire were also reviewed.Results:Twelve months after surgery,BCVA was not significantly different in UT-DSAEK and DMEK eyes(0.10±0.04 and 0.07±0.07 logMAR,respectively);at both 4-and 6 mm optical zones total and posterior corneal higher order aberrations(HOAs),posterior astigmatism and total coma were significantly lower after DMEK;BCVA in both groups was significantly correlated mainly with anterior corneal aberrations;contrast sensitivity was higher after DMEK especially in mesopic conditions and at medium spatial frequencies;the endothelial cell density was similar,although slightly higher in the UT-DSAEK group(p=0.10).The satisfaction questionnaire showed that although patients were highly satisfied from both procedures,more than half of them preferred DMEK and reported a more comfortable and quicker postoperative recovery.Conclusions:DMEK and UT-DSAEK showed no evidence of difference in terms of postoperative BCVA,although DMEK had a better performance in terms of contrast sensitivity,posterior corneal aberrations and overall patient satisfaction.

DSAEK手术植片厚度和大小对角膜内皮细胞密度的远期影响

目的探讨角膜后弹力层剥除联合自动角膜刀取材内皮移植术(DSAEK)供体中央植片厚度(CGT)和大小对角膜内皮细胞密度(ECD)的远期影响。方法采用系列病例观察研究,收集2013年1月至2017年12月因角膜内皮功能失代偿在北京大学第三医院眼科中心接受DSAEK手术并严格完成2年或以上随访的患者134例144眼。采用角膜内皮镜测量术前供体ECD;术后1、3、6、12和24个月,采用激光扫描共聚焦显微镜测量术后ECD,计算角膜内皮细胞丢失率;采用眼前节光相干断层扫描仪测量供体CGT。根据术后3个月供体CGT将患者分为薄植片组45眼、中等厚植片组66眼和厚植片组33眼,分别为供体CGT<100μm、≥100~<150μm和≥150μm。根据角膜环钻切割的供体植片大小将患者分为小植片组31眼和大植片组113眼,分别为供体植片直径≥7~<8 mm和≥8~<9 mm。比较手术后供体CGT变化及术后不同时间点角膜内皮细胞丢失率;分析术后24个月ECD与术前供体植片ECD、大小及CGT的相关性。结果术后1、3、6、12和24个月供体CGT分别为129.0(90.8,160.8)、115.5(93.0,146.0)、115.5(89.0,151.0)、112.5(94.3,146.8)和114.0(89.0,144.5)μm,总体比较差异有统计学意义(H=37.369,P<0.001),其中术后1个月供体CGT与术后3个月相比差异有统计学意义(P<0.001)。术后1、3、6、12、24个月,薄植片组、中等厚植片组和厚植片组以及大植片组、小植片组角膜内皮细胞丢失率比较差异均无统计学意义(均P>0.05)。Spearman相关性分析显示,术后24个月时ECD与术前供体植片ECD呈强正相关(r_(s)=0.783,P<0.001),与供体植片大小和CGT均无明显相关性(r_(s)=0.141,P=0.093;r_(s)=-0.044,P=0.600)。结论术前供体植片ECD越大,术后ECD越大;供体植片越薄、直径越大,DSAEK术后远期角膜内皮细胞丢失率越低。

移植物厚度对角膜内皮失代偿行简易后弹力层角膜内皮移植效果的影响

背景:研究表明较薄移植物视力恢复更快、排斥风险更低,国内缺乏对内皮移植术后不同植片厚度的临床疗效分析,因此,确定最佳移植物厚度对于提高手术疗效至关重要。目的:评价简易后弹力层剥离内皮角膜移植术后不同植片厚度对视力恢复及其他预后指标的影响。方法:选取2013年1月至2023年2月在北部战区总医院接受简易后弹力层剥离内皮角膜移植手术治疗的角膜内皮失代偿患者共72例(72眼),其中薄植片组(<100μm)32例(32眼),厚植片组(≥100μm)40例(40眼)。随访1年,观察两组术前及术后1,3,6,12个月的最佳矫正视力,术后1年角膜内皮细胞数、角膜植片透明度、术后并发症、植片生存情况。结果与结论:①两组患者术后视力较术前均有显著提高,薄植片组患者术后3个月最佳矫正视力优于厚植片组(P<0.05);②两组术后1年角膜内皮细胞数及植片透明度比较差异无显著性意义(P>0.05);③两组患者继发性青光眼、植片免疫排斥、植片移位等术后并发症发生率比较差异无显著性意义(P>0.05);④两组术后1年植片生存率比较差异无显著性意义(93.8%,92.3%,P>0.05);⑤结论:简易后弹力层剥离内皮角膜移植术是一种安全有效的角膜内皮移植手术方式,其术后疗效与传统后弹力层剥离内皮角膜移植术相似,而且植片植入方式更为简便。较薄植片能够更早提供最佳矫正视力,更早完成角膜重塑,因此在治疗角膜内皮失代偿疾病时,优先选择薄移植物来提高恢复时间。

飞秒激光辅助角膜内皮移植术治疗大泡性角膜病变的疗效观察

目的:评估飞秒激光辅助的后弹力层撕除角膜内皮移植术治疗大泡性角膜病变的临床疗效及安全性。方法:回顾性分析2013-03/2014-02在我科住院治疗的大泡性角膜病变患者15例16眼,其中男7例7眼,女8例9眼,平均年龄66.3±18.4岁,采用飞秒激光制作薄层角膜内皮植片,进行后弹力层撕除角膜内皮移植术。术后随访12mo,观察角膜刺激症状消退、植片恢复和并发症等情况,观测指标包括最佳矫正视力、眼压、前节光学相干断层扫描及角膜内皮细胞计数。结果:所有患者手术顺利,无术中并发症发生;术后眼压正常,最佳矫正视力较术前不同程度提高。角膜刺激症状自术后1d开始逐渐减轻,术后3wk完全缓解。术后1眼(6%)发生内皮植片脱位,3眼(19%)植片与植床之间存在局灶性层间积液。术后1mo角膜上皮变光滑,基质水肿消退,中央角膜厚度(638±86.51μm)较术前(811±137.55μm)明显变薄。随访期间,发生植片急性排斥反应和植片内皮功能失代偿各1眼(6%)。末次随访,角膜内皮细胞计数为1687±507个/mm2。结论:应用飞秒激光辅助后弹力层撕除角膜内皮移植术治疗角膜内皮病变,可以个体化、精确、高效地制作内皮植片,手术安全性高,术后恢复快。

角膜内皮移植术新进展

角膜内皮移植术在国内外临床应用中均取得良好的效果,现已成为治疗严重角膜内皮病变的首选方法。其保留了患者自体健康的角膜上皮层、前弹力层和基质层,尽可能维持了眼表的完整性,减少了散光。此种手术方法的特点是损伤小、排斥反应少,视力恢复快。后弹力层剥除角膜内皮移植术是目前流行的手术方式,而后出现的飞秒激光的运用和后弹力层角膜内皮移植术向我们展示了其先进性。文中就角膜内皮移植的发展进程、手术方式以及并发症等进行综述。

不同病因对角膜内皮移植术后视力的影响

背景 角膜后弹力层剥除联合自动角膜刀取材内皮移植术（DSAEK）是目前治疗角膜内皮失代偿的首选术式,但不同角膜病变患者术后视力恢复情况国内外的报道有所不同. 目的 比较不同病因所致角膜内皮失代偿患者DSAEK术后视功能的恢复情况,评价不同角膜病变对DSAEK术后视力的影响. 方法 回顾性分析2007年12月至2009年12月在北京大学第三医院眼科就诊的角膜内皮失代偿患者67例71眼的临床资料,根据原发病因的不同将其分为Fuchs角膜内皮营养不良组19例22眼、白内障术后大泡性角膜病变组36例37眼及其他因素引起的角膜内皮失代偿者（其他病因组）12例12眼,所有患眼均行DSAEK,分析其术后第1、3、7、30、90、180天各组术眼视力改善情况,采用SPSS 16.0统计学软件的x2检验和重复测量两因素方差分析对各组术眼手术前后不同视力的眼数分布及不同病因组在不同时间点LogMAR视力的差异进行比较. 结果 入选的71眼中,71.83％的患眼术前视力低于0.1,所有患眼视力均低于0.3.术前Fuchs角膜内皮营养不良组、白内障术后大泡性角膜病变组和其他病因组总体比较视力差异无统计学意义（x2=3.427,P＞0.05）.术后第1 80天,Fuchs角膜内皮营养不良组视力≥0.8者5眼,占22.73％,略高于白内障术后大泡性角膜病变组的10.81％和其他病因组的8.33％,但3个组间不同视力的眼数分布差异无统计学意义（x2=0.330,P＞0.05）.3个组患眼随着术后时间的延长,LogMAR视力值逐渐下降,差异有统计学意义（F时间=88.000,P＜0.01）;术后第7天,白内障术后大泡性角膜病变组LogMAR视力值为1.29±177;0.57,明显高于Fuchs角膜内皮营养不良组的0.82±177;0.43和其他病因组的0.91±177;0.39,差异均有统计学意义（P＜0.05）;术后第90天,Fuchs角膜内皮营养不良组LogMAR视力值为0.40±177;0.28,明显低于白内障术后大泡性角膜病变组的0.64±177;0.44和其他病因组的0.73±177;0.54,差异均有统计学意义（P＜0.05）;而术后第180天,3个组间LogMAR视力值的差异均无统计学意义（P＞0.05）.Fuchs角膜内皮营养不良组视力在术后3个月时达稳定,白内障术后大泡性角膜病变组和其他病因组术后90～ 180 d视力仍有变化. 结论 DSAEK是治疗各种角膜内皮失代偿的有效方法,Fuchs角膜内皮营养不良、白内障术后大泡性角膜病变和其他病因引起的角膜病变行DSAEK术后6个月视力均恢复较好,但Fuchs角膜内皮营养不良患者术后视力恢复更快.

后弹力层角膜内皮移植术

后弹力层角膜内皮移植术(DSEK)是一项新近开展起来的眼科手术,主要用于治疗因角膜内皮功能不良引起的角膜失代偿。虽然DSEK手术应用于临床尚不足4年,但因其术后视力恢复快,与传统角膜移植手术相比,极大地降低了术后并发症的发生,而迅速成为角膜内皮功能不良患者行角膜移植的首选手术。由于其应用时间短,远期疗效尚待观察。就后弹力层角膜内皮移植术的手术特点以及与传统角膜移植手术相比较的优缺点进行综述。

后弹力层剥除联合角膜内皮移植手术技巧在大泡性角膜病变中的应用

目的:观察改良的角膜后弹力层剥除联合自动角膜刀取材内皮移植术(DSAEK)手术技巧在大泡性角膜病变中的应用。方法:回顾性分析2018-12/2019-12在我科住院治疗的大泡性角膜病变患者10例10眼,均行DSAEK术,除常规手术步骤,术中在前房灌注管设置、切口设计及角膜周边穿刺等手术技术上进行改进。术后随访6mo,观察角膜植片恢复情况和植片脱位、前房反应等并发症发生情况,评估最佳矫正视力(BCVA)、角膜中央厚度(CCT)、角膜内皮细胞计数(ECD)情况。结果:所有患者均顺利完成手术,无术中并发症发生,术后未见植片脱位和层间积液发生。术后眼压正常,BCVA较术前均有不同程度改善。角膜畏光、眼磨等刺激症状自术后1d开始逐渐减轻,术后2wk完全缓解。术后1mo角膜基质水肿消退,CCT(596.8±19.11μm)较术前(874.0±58.64μm)明显变薄。随访期间,所有患者病情稳定,角膜植片保持透明,但角膜内皮细胞计数均有不同程度衰减。结论:DSAEK术中手术技巧的改进可以明显减少大泡性角膜病变患者术中和术后并发症,提高手术安全性和有效性。

角膜内皮移植术不同时期并发症的成因及处理

随着角膜内皮移植术在国内外的广泛开展和应用,角膜内皮移植术作为目前治疗角膜内皮失代偿的较理想术式,其优点不言而喻,但也存在植片制备、术中及术后发生并发症的可能。本文以2种常见的角膜内皮治疗术式——角膜后弹力层剥除内皮移植术和角膜后弹力层内皮移植术为例,从植片制备并发症(如植片穿孔、植片撕裂)、术中并发症(如植片展开困难、植片倒置)和术后并发症(如植片脱落、术后高眼压)等方面详细介绍不同并发症对应的处理方法。通过对角膜内皮移植术不同时期并发症的发生、影响因素及处理方法等方面的研究进展进行综述,以期为临床医师对角膜内皮移植术各期并发症的诊疗提供参考。