[深板层角膜移植术治疗深层感染性化脓性角膜炎的初步临床结果]

Gao Hua, Jia Yan-ni, Ding Gang, Song Peng, Li Su-xia, Wang Shu-ting, Shi Wei-yun

Shangdong Eye Institute, Shandong Eye Hospital, Jinan 250021, China.

Shangdong Eye Institute, Shandong Eye Hospital, Jinan 250021, China. Email:

Zhonghua Yan Ke Za Zhi. 2013 Oct;49(10):884-9.

OBJECTIVE

To evaluate the clinical results of deep anterior lamellar keratoplasty (DALK) assisted by big bubble technique in the treatment of deep infectious purulent keratitis.

METHODS

Seventeen patients (17 eyes) with deep infectious purulent keratitis received DALK surgery in Shandong Eye Hospital from January 2011 to March 2012. Case selection:Patients with purulent keratitis, the infection or infiltrate depth was more than four fifth corneal thickness;

SURGICAL TECHNIQUE

Use DALK assisted by big bubble technique to cut off the lesions and expose the Descemet's membrane. The prepared donor which stored in D-X medium or in glycerine preoperatively was oversized by 0.25 mm, and after stripping of Descemet's membrane, the donor button was interrupted sutured with 10-0 nylon suture. The perioperative complications, recurrence, graft status and visual recovery were evaluated.

RESULTS

The mean follow up time were 9 months.17 patients with average age of (46 ± 13) year old received DALK surgery, including 14 cases of fungal keratitis and 3 cases of bacteria keratitis. Perioperative complications:Two cases suffered micro perforation and were continuing performed DALK surgery after injecting air bubble in the anterior chamber. Three cases suffered double anterior chamber, one was resolved after graft resuture, and the other two were absorbed automatically.One patient suffered fungal recurrence and cured with secondary penetrating keratoplasty. Graft status:All grafts attached closely to the recipients, slit lamp and AS-OCT examinations were difficult to distinguish the interface. All of grafts were transparent. Visual acuity:before the operation best corrected visual acuity (BCVA) in patients with HM/20 cm to 3.7, after the surgery patients' BSCVA improved to 4.5-5.0. The mean astigmatism postoperatively of 16 cases received successful DALK finally was (4.53 ± 2.35) D .

CONCLUSIONS

For patients with deep infectious purulent keratitis, big bubble technique assistants DALK surgery is still a safe and effective method.

目的

评估大泡技术辅助的深板层角膜移植术（DALK）治疗深层感染性化脓性角膜炎的临床效果。

方法

2011年1月至2012年3月，17例（17眼）深层感染性化脓性角膜炎患者在山东眼科医院接受了DALK手术。病例选择：化脓性角膜炎患者，感染或浸润深度超过角膜厚度的五分之四。

手术技术

采用大泡技术辅助的DALK切除病变并暴露后弹力层。术前储存在D-X培养基或甘油中的供体片直径加大0.25mm，后弹力层剥除后，用10-0尼龙缝线间断缝合供体植片。评估围手术期并发症、复发情况、植片状态和视力恢复情况。

结果

平均随访时间为9个月。17例平均年龄（46±13）岁的患者接受了DALK手术，其中真菌性角膜炎14例，细菌性角膜炎3例。围手术期并发症：2例发生微小穿孔，前房注入气泡后继续进行DALK手术。3例发生双前房，1例经植片重新缝合后恢复，另外2例自行吸收。1例患者真菌复发，二次穿透性角膜移植治愈。植片状态：所有植片与受体紧密贴合，裂隙灯和AS-OCT检查难以区分界面。所有植片均透明。视力：术前患者最佳矫正视力（BCVA）为HM/20cm至3.7，术后患者的最佳矫正视力（BSCVA）提高到4.5-5.0。最终16例成功接受DALK手术患者术后平均散光为（4.53±2.35）D。