Wylegała Edward, Wróblewska Ewa Marta, Tarnawska Dorota, Mierzwa Marzena
Oddziału Okulistycznego Okregowego Szpitala Kolejowego w Katowicach.
Klin Oczna. 2003;105(5):263-6.
To present own experiences in the surgery of deep lamellar keratoplasty.
25 eye of 25 patients suffering from various corneal pathologies with preserved endothelium: 22 with keratoconus eyes, 2 with post-inflammatory scar and one eye with leucoma in Stevens-Johnson syndrome. Mean follow-up was 25.5 months (from 6 to 32). Main outcome measures were Non-Corrected and Best Corrected Visual Acuity (NCVA, BCVA), astigmatism, refractive error, IOP and corneal transparency. The surgery was performed in general anesthesia. In majority of cases the recipient stroma was trephined to a depth of 70% with 7.5 mm diameter vacuum trephine. In cases of intraoperative perforation of Descemet membrane with shallow anterior chamber we converted the procedure into penetrating keratoplasty. The donor lenticule was trephined in the artificial chamber with the 0.5 mm oversized manual trephine to a depth of 90%. In two cases after DLK was finished, limbal stem cell grafting was additionally performed.
Postoperative NCVA ranged from 0.01 to 0.8 and BCVA from 0.1 to 0.8. Astigmatism ranged from 0.5 to 10.0 D. Refractive error ranged from -8.0 to +1.0 D. In follow-up period all grafts maintained transparent. The complications were mainly intraoperative perforations of Descemet membrane (9 cases): in 7 cases we convert the procedure into penetrating keratoplasty. In 2 cases the double chamber-forming was observed: in one case on 7 day following surgery the penetrating keratoplasty was performed, in other a spontaneous attachment was observed. We also observed loose sutures in 2 cases, inflammatory infiltrates in one case. Two cases of ocular hypertension was successfully treated by medication.
Deep lamellar keratoplasty is an effective procedure for treating various diseases of corneal stroma with unaffected endothelium.
介绍本人在深板层角膜移植手术中的经验。
25例患者的25只眼，患有各种角膜病变且内皮保留：22例圆锥角膜眼，2例炎症后瘢痕，1例史蒂文斯-约翰逊综合征中的角膜白斑。平均随访时间为25.5个月（6至32个月）。主要观察指标为未矫正视力和最佳矫正视力（NCVA、BCVA）、散光、屈光不正、眼压和角膜透明度。手术在全身麻醉下进行。大多数情况下，用直径7.5mm的真空环钻将受体基质钻至70%深度。术中如果后弹力层穿孔且前房浅，则将手术改为穿透性角膜移植术。供体角膜片在人工前房内用0.5mm超大号手动环钻钻至90%深度。在2例深板层角膜移植完成后，额外进行了角膜缘干细胞移植。
术后NCVA范围为0.01至0.8，BCVA范围为0.1至0.8。散光范围为0.5至10.0D。屈光不正范围为-8.0至+1.0D。在随访期间，所有移植片均保持透明。并发症主要是术中后弹力层穿孔（9例）：7例将手术改为穿透性角膜移植术。2例观察到双前房形成：1例在术后7天进行了穿透性角膜移植术，另1例观察到自发粘连。还观察到2例缝线松动，1例有炎症浸润。2例高眼压经药物治疗成功。
深板层角膜移植是治疗内皮未受影响的各种角膜基质疾病的有效方法。
