410·中华眼科杂志2011年5月第47卷第5期ChinJOphthalmol，May2011，Vo1．47，No．5不剥除后弹力层的角膜内皮移植术治疗虹膜角膜内皮综合征的角膜失代偿吴护平董诺谢素贞李程李学治刘昭升【摘要】目的探讨不剥除后弹力层的角膜内皮移植术治疗虹膜角膜内皮综合征的角膜失代偿的可行性和临床疗效。方法回顾性非对照性系列病例研究。选择2008年1月至2009年12月在厦门大学附属厦门眼科中心住院的虹膜角膜内皮综合征的角膜失代偿7例患者，进行不剥除后弹力层的角膜内皮移植术。术后随访3—12个月，应用裂隙灯显微镜、前节相干光断层成像术、超声活体显微镜和激光共焦角膜显微镜观察植片透明度及植片贴附和植片移位等情况，应用角膜内皮细胞分析仪测量角膜内皮细胞密度，并对比手术前后的视力。结果术后无1例免疫排斥反应、植片移位及晶状体损伤发生。3例患者术后第2天出现继发性青光眼，给予20％甘露醇静脉滴注，3例术后第3天随前房空气的逐渐吸收而眼压下降。1例术后高眼压控制不佳，在术后2周行睫状体光凝术后眼压控制正常。7例患者植片均透明，激光共焦角膜显微镜显示术后供受体界面、供体角膜基质的高反光性随着时间明显下降，前节光学相干断层成像术及超声生物显微镜显示角膜内皮植片与受体内皮面贴附良好且虹膜及角膜内皮粘连分离。6例患者术后最佳矫正视力均有不同程度的提高；1例患者术后视力不提高的原因为青光眼性视神经萎缩。术后平均角膜内皮细胞密度为(2176．6±267．6)个／mm。结论不剥除后弹力层的角膜内皮移植术治疗虹膜角膜内皮综合征的角膜失代偿具有安全、有效、操作简便等特点，有望成为治疗该病的手术方式之一。华聪科杂志，2011，47：410-415)【关键词】角膜后弹力层；角膜移植；内皮，角膜；角膜疾病；虹膜疾病Non-DescemetstrippingendothelialkeratoplastyfortreatingiridocornealendothelialsyndromeinphakiceyesUHu-ping，DONGNuo，XIESu—zhen，LICheng，12Xue—Zhi，12UZhao—sheng．OcularSu~CaceandCornealDiseaseDepartment，theAffiliatedXiamenEyeCenterofXiamenUniversity，Xiamen361001，ChinaCorrespondingauthor：Hu-ping，Email：ykzxkjb@163．corn【Abstract】0bjectiveToinvestigatethefeasibilityandclinicaleffectsofnon—Descemetstrippingendothelialkeratoplasty(nDSEK)ontreatingiridocornealendothelial(ICE)syndromeinphakiceyes．MethodsRetrospectivenoncomparativeinterventionalcaseseries．7patients(7eyes)withICEsyndromeattheAfiliatedXiamenEyeCenterofXiamenUniversityfromJanuary2008toDecember2009underwentnon—Descemetstrippingendothelialkeratoplasty．Allpatientswerefollowedupfor3-12months，pre—andpostoperativebestcorrectedvisualacuity(BCVA)werecompared，theadherenceofthedonordisctotherecipientendotheliumandpostoperativedonordiscdislocationweremonitoredduringthefollow—upperiod．Graftclearanceandendothelialcelldensity(ECD)wereobserved，too．ResultsAfternDSEK，noprimarygraftfailuresdislocationanddecenteredgraftoccurredduringthefollow—upperiod．Studygroupintraoperativecomplicationsincluded3casewithelevatedintraocularpressure2daypostoperatively．Subepithelialhaze，donor—recipientinterfacehaze，andinterfaceparticleswereobservedinallmeasurablecasesbyinvivolaserconfocalmicroscopy．Anteriorsegmentopticalcoherencetomographyandultrasoundbiomicroscopyshowedtheadherenceofthedonordisctotherecipientendotheliumandperipheralanteriorsynechiaewereseparated．A1lcorneasremainedclearduringthefollow．uD．6patientshadimprovedBCVAwhile1patienthadthesameBCVA．ThereasonforpoorVAwasopticatrophyduetoglaucoma．PostoperativemeanEDCwas(2176．6±267．6)cells／mm．ConclusionsnDSEKforiridocorneaIendothelial(ICE)syndromeisfeasible，technicallyeasy，safeandeffective．ItcanbeoneofthesurgicalDOI：10．3760／cma．j．issn．04124081．2011．05...
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