Amayem Ashraf F, Terry Mark A, Helal Magdi H, Turki Walid Al, El-Sabagh Hazem, El-Gazayerli Erfan, Ousley Paula J
Magrabi Eye Center, Jeddah, Saudi Arabia.
Cornea. 2005 Jul;24(5):587-92. doi: 10.1097/01.ico.0000153558.67031.15.
This study was designed to report the use of deep lamellar endothelial keratoplasty (DLEK) in combination with other intraocular surgeries in the treatment of eyes with severe bullous keratopathy and visual loss.
DLEK surgery was performed in six patients with severe bullous keratopathy and preoperative vision with a range of between count fingers and light perception only. DLEK was combined with vitrectomy and placement of a ciliary sulcus sutured intraocular lens in four patients and with cataract surgery in one patient. Two patients with vitreoretinal disease underwent pars plana vitrectomy within only 4 months after the DLEK donor tissue had been placed. Graft clarity, Snellen visual acuities, refractive astigmatism, endothelial cell counts, and corneal topography were prospectively measured at 6 and 12 months postoperatively.
At 6 months after DLEK surgery, all grafts were clear and vision improved in all patients. Best spectacle-corrected visual acuity improved from count fingers level (or worse) before surgery to a range of 20/40 to 20/200 after surgery. Average refractive astigmatism at 6 months was 2.0 diopters (range, 0.50-4.00 diopters). The average postoperative endothelial cell count was 1,679 +/- 380 (range, 1,200-2,298) cells/mm at 6 months and 1,449 +/- 365 (range, 1,105-2,043) cells/mm at 12 months. Vitreoretinal surgery subsequent to graft placement did not affect corneal clarity or dislodge the grafted tissue.
DLEK surgery can be used in cases with severe visual loss caused by bullous keratopathy with transfer of healthy donor endothelium, clearing of the central cornea, and restoration of useful vision. DLEK also can be successfully combined with other intraocular surgeries such as vitrectomy, intraocular lens exchange, and sutured intraocular lens surgery. The DLEK graft can tolerate subsequent intraocular surgery performed as early as 3 months after placement of the donor tissue.
本研究旨在报告深层板层角膜内皮移植术（DLEK）联合其他眼内手术治疗严重大泡性角膜病变及视力丧失患者的应用情况。
对6例严重大泡性角膜病变且术前视力仅为指数至光感的患者施行DLEK手术。其中4例患者DLEK联合玻璃体切除术及睫状沟缝线固定人工晶状体植入术，1例患者联合白内障手术。2例玻璃体视网膜疾病患者在植入DLEK供体组织仅4个月后接受了经平坦部玻璃体切除术。术后6个月和12个月前瞻性测量植片清晰度、Snellen视力、屈光性散光、内皮细胞计数及角膜地形图。
DLEK手术后6个月，所有植片均清晰，所有患者视力均有改善。最佳矫正视力从术前的指数水平（或更差）提高到术后20/40至20/200。6个月时平均屈光性散光为2.0屈光度（范围0.50 - 4.00屈光度）。术后6个月平均内皮细胞计数为1679±380个/mm²（范围1200 - 2298个/mm²），12个月时为1449±365个/mm²（范围1105 - 2043个/mm²）。植片植入后进行的玻璃体视网膜手术未影响角膜清晰度或使移植组织移位。
DLEK手术可用于因大泡性角膜病变导致严重视力丧失的病例，能移植健康的供体内皮，清除中央角膜混浊，恢复有用视力。DLEK还可成功联合其他眼内手术，如玻璃体切除术、人工晶状体置换术及缝线固定人工晶状体手术。DLEK植片能够耐受供体组织植入后最早3个月进行的后续眼内手术。
