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小切口Descemet膜剥除内皮角膜移植术的实验研究

[Experimental research of small-incision Descemet's stripping endothelial keratoplasty].

作者信息

Hong Jing, Liu Guang-Feng, Xia Ning, Gu Shao-Feng, Han Jing-Yi, Chai Li-Jing

机构信息

The Eye Center, Third Hospital, Peking University, Beijing 100083, China.

出版信息

Zhonghua Yan Ke Za Zhi. 2008 Feb;44(2):122-7.

Abstract

OBJECTIVE

To investigate the surgical procedure, clinical efficacy, complications, density of endothelial cells and histological changes after Descemet's stripping endothelial keratoplasty (DSEK) surgery.

METHODS

It was a experimental study. Twenty four New Zealand rabbits were divided into 3 groups, 8 rabbits per group. Donor grafts were dissected from 16 New Zealand rabbit eyes. Group A was experimental group, a 5 mm limbal tunnel incision was made. Descemet's membrane was striped off at 10 mm diameter, then the same diameter donor cornea (including Descemet's membrane and endothelium with a little of posterior stroma) was inserted into the recipient's anterior chamber. Air was injected into the anterior chamber to press the graft up against the recipient cornea. Group B was the control group, only striped the Descemet's membrane at the recipient cornea. Group C was the experiment control group, the procedure was similar to the group A, but the donor graft was without endothelial cells.

RESULTS

All corneas of group A were transparent, and the mean density of the endothelial cells was (2195 +/- 77)/mm2 (t = 12.455, P < 0.001). Endothelial grafts attached to the recipients well and no scar formation between them under histological observation. The corneas were severe edema in groups B and C one month after surgery.

CONCLUSIONS

DSEK is a safe surgery, can be recovered rapidly with little damages, and without interface scar formation after surgery. DSEK may be the first choice for the treatment of bullous keratopathy.

摘要

目的

探讨深板层内皮角膜移植术(DSEK)的手术操作、临床疗效、并发症、内皮细胞密度及组织学变化。

方法

本研究为实验性研究。将24只新西兰兔分为3组,每组8只。从16只新西兰兔眼中获取供体植片。A组为实验组,制作5mm的角膜缘隧道切口。在直径10mm处剥离后弹力层,然后将相同直径的供体角膜(包括后弹力层和内皮细胞及少量后基质)植入受体前房。向前房内注入空气将植片压贴于受体角膜上。B组为对照组,仅在受体角膜上剥离后弹力层。C组为实验对照组,手术操作与A组相似,但供体植片无内皮细胞。

结果

A组所有角膜均透明,内皮细胞平均密度为(2195±77)/mm²(t = 12.455,P < 0.001)。组织学观察显示内皮植片与受体贴附良好,二者之间无瘢痕形成。B组和C组术后1个月角膜出现严重水肿。

结论

DSEK是一种安全的手术,损伤小,恢复快,术后无界面瘢痕形成。DSEK可能是大泡性角膜病变治疗的首选方法。

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