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引用:程燕,吴洁,朱海峰,惠玲,李波.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.国际眼科杂志 2020;20(8):1456-1459,doi:10.3980/j.issn.1672-5123.2020.8.35
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
Surgical techniques and clinical observation of Descemet's stripping automated endothelium keratoplasty in bullous keratopathy
投稿时间:2020-04-01  修订日期:2020-07-01
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DOI:10.3980/j.issn.1672-5123.2020.8.35
关键词:  角膜移植术  后弹力层剥除联合角膜内皮移植术  大泡性角膜病变  手术技巧
Key Words:  keratoplasty  descemet stripping automatic endothelial keratoplasty  bullous keratopathy  surgical techniques
基金项目:西安市科技计划项目\〖No.2017116SF/YX010(6)\〗
Fund Project:Xi'an Science and Technology Plan Project \〖No.2017116SF/YX010(6)\〗
              
作者单位
程燕 中国陕西省西安市,西北大学附属第一医院 西安市第一医院 陕西省眼科疾病临床医学研究中心
吴洁 中国陕西省西安市,西北大学附属第一医院 西安市第一医院 陕西省眼科疾病临床医学研究中心
朱海峰 中国陕西省西安市,西北大学附属第一医院 西安市第一医院 陕西省眼科疾病临床医学研究中心
惠玲 中国陕西省西安市,西北大学附属第一医院 西安市第一医院 陕西省眼科疾病临床医学研究中心
李波 中国陕西省勉县医院眼科
              
AuthorInstitution
Yan Cheng First Affiliated Hospital of Northwest University, Xi'an First Hospital, Ophthalmic Disease Clinical Medical Research Center of Shaanxi, Xi'an , Shaanxi Province, China
Jie Wu First Affiliated Hospital of Northwest University, Xi'an First Hospital, Ophthalmic Disease Clinical Medical Research Center of Shaanxi, Xi'an , Shaanxi Province, China
Hai-Feng Zhu First Affiliated Hospital of Northwest University, Xi'an First Hospital, Ophthalmic Disease Clinical Medical Research Center of Shaanxi, Xi'an , Shaanxi Province, China
Ling Hui First Affiliated Hospital of Northwest University, Xi'an First Hospital, Ophthalmic Disease Clinical Medical Research Center of Shaanxi, Xi'an , Shaanxi Province, China
Bo Li Department of Ophthalmology, Mian County Hospital, Mian County , Shaanxi Province, China
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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。

Abstract:
      AIM: To evaluate the clinical effects and safety of surgical techniques in Descemet stripping automatic endothelial keratoplasty(DSAEK)in bullous keratopathy.

     METHODS: A retrospective analysis of 10 patients with bullous keratopathy treated in our hospital from December 2018 to December 2019 in our hospital, including 4 males(4 eyes), 6 females(6 eyes). Descemet stripping automatic endothelial keratoplasty(DSAEK)was performed with every patient. In addition to the conventional surgical procedures, the surgical technique such as the setting of the anterior chamber perfusion tube, the design of the incision, and the peripheral corneal puncture during the operation were performed. Follow-up for 6mo, the recovery of corneal grafts and postoperative dislocations, double anterior chambers, and other complications were observed, including best corrected visual acuity(BCVA), anterior segment optical coherence tomography, corneal endothelial cell count and incidence of postoperative complications.

     RESULTS: All patients had smooth surgery, no intraoperative complications occurred, and no postoperative dislocations or interlaminar effusions occurred; postoperative intraocular pressure was normal, and the BCVA was improved to different degrees than before surgery. The symptoms such as tearing and photophobia gradually reduced from 1d after surgery, and completely relieved after 2wk. Corneal stroma edema decreased within 1mo after operation, and the central corneal thickness(596.8±19.11μm)was significantly thinner than that before operation(874.0±58.64μm). During the follow-up period, all patients were stable and the corneal grafts remained transparent, but the corneal endothelial counts were reduced to varying degrees.

     CONCLUSION: The application of surgical techniques in DSAEK can significantly reduce intraoperative and postoperative complications, improve the safety of surgery, and has clinical value in bullous keratopathy.

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