Bourne W M, O'Fallon W M
Am J Ophthalmol. 1978 Jun;85(6):760-6. doi: 10.1016/s0002-9394(14)78102-4.
We studied the central donor endothelium of 27 clear, penetrating corneal transplants with the specular microscope before and after keratoplasty. We examined the donor corneas first, in vitro, while they were immersed in McCarey-Kaufman preservation medium before transplantation. This preoperative examination proved valuable for screening donor corneas, several of which were not used on the basis of the specular microscopic appearance alone. We examined the donor endothelium again within one week after keratoplasty and calculated the number of endothelial cells per square millimeter from photographs. The reproducibility of the counting method was acceptable. Comparison of the examinations before and after transplantation on each patient showed that, on the average, 23% of the donor endothelial cells were lost during keratoplasty. The 12 phakic transplants lost significantly more endothelial cells than did the 15 aphakic grafts (37% vs 12%). A possible explanation for the increased cell loss in phakic keratoplasties is the shallow anterior chamber present during the initial placement of the graft. Phakic grafts that were larger or had shorter time intervals between donor death and enucleation lost fewer cells. Aphakic transplants had larger postoperative corneal thicknesses than did phakic transplants.
我们用镜面显微镜研究了27例透明穿透性角膜移植术患者角膜移植术前、后的中央供体内皮细胞。我们首先在体外检查供体角膜，即在移植前将其浸泡在麦卡里-考夫曼保存液中时进行检查。这种术前检查对筛选供体角膜很有价值，其中有几个供体角膜仅根据镜面显微镜下的外观就未被使用。我们在角膜移植术后一周内再次检查供体内皮细胞，并根据照片计算每平方毫米内皮细胞的数量。计数方法的可重复性是可以接受的。对每位患者移植前后的检查结果进行比较发现，平均而言，角膜移植术中23%的供体内皮细胞丢失。12例有晶状体移植丢失的内皮细胞明显多于15例无晶状体移植（37%对12%）。有晶状体角膜移植术中细胞丢失增加的一个可能原因是移植最初放置时前房较浅。较大的有晶状体移植或供体死亡与眼球摘除之间时间间隔较短的有晶状体移植丢失的细胞较少。无晶状体移植术后角膜厚度比有晶状体移植厚。
