“非折叠植入法”的角膜内皮移植术治疗大泡性角膜病变1例

发布时间：2018-07-20 21:04

【摘要】： 目的：报告应用“非折叠植入法”的角膜内皮移植术治疗大泡性角膜病变1例的临床效果。方法：选择2009年在我院诊断大泡性角膜病变的患者1例,对病例右眼行“非折叠植入法”的角膜内皮移植术,术中将供体植片内皮面向下放置于术眼鼻侧角巩膜隧道口对应的球结膜表面(非折叠形式放置),以23G眼内镊自颞侧角膜侧切口伸入,经鼻侧角巩膜隧道口伸出,夹取内皮植片边缘将其拖入前房(非折叠植入法),调位居中。术后随诊至今(6个月),同时记录术后视力、术后角膜植片／植床、内皮情况及术中、术后各种并发症。结果：术后患者视力逐渐恢复,前房内空气于一周内吸收完全,裂隙灯及眼前节OCT检查显示内皮植片与术眼角膜内层基质贴附良好,无植片脱位,无眼压升高,术后4个月时最佳矫正视力达到0.4,未见其它并发症发生。术后4个半月时,患者自行停药,遂发生植片内皮型排斥反应,予以积极抗排斥治疗,视力恢复良好。随访至今,最佳矫正视力为0.6,角膜内皮镜检查显示角膜内皮细胞密度为1981个／mm2。结论：本报告中,采用角膜内皮移植术治疗大泡性角膜病变一例,术中采用“非折叠植入法”植入内皮植片,与其他内皮移植术相比较,无需特殊植入器械,并可适当的减少植片内皮的损伤,且前房空间要求低。以往报道内皮移植排斥反应发生率低,本报道患者术后4个半月时发生了内皮型排斥反应,建议对该种术式患者仍应严格长期使用预防排斥反应的药物,远期效果有待进一步观察。
[Abstract]:Objective: to report the clinical effect of non-foldable keratoendothelium transplantation in the treatment of 1 case of bullous keratopathy. Methods: a case of corneal endothelium transplantation with "non-foldable implantation" was performed on the right eye of one patient who was diagnosed as bullous keratopathy in our hospital in 2009. During the operation, the skin surface of the donor graft was placed downward on the conjunctiva surface (in a non-folded form) corresponding to the tunnel orifice of the keroscleral tunnel of the nasal side of the eye, and the 23 gigabyte forceps were inserted from the temporal keratotomy, and extended through the nasal keroscleral tunnel. Clip the edge of the endothelial graft and drag it into the anterior chamber (non-folded implant) and adjust the position. The postoperative visual acuity, corneal grafts / beds, endothelium and complications were recorded. Results: the visual acuity of the patients gradually recovered, the air in anterior chamber was absorbed completely within one week. Slit lamp and Oct examination showed that the endothelium grafts adhered well to the inner corneal stroma, no graft dislocation and no intraocular pressure increased. The best corrected visual acuity (BCVA) reached 0.4 at 4 months after operation, and no other complications occurred. Four and a half months after the operation, the patient stopped the drug, and then the graft endothelial rejection occurred, and positive anti-rejection treatment was given, and the visual acuity recovered well. Up to now, the best corrected visual acuity (BCVA) was 0.6, and the corneal endothelial cell density was 1 81 / mm ~ (2). Conclusion: in this report, corneal endothelium transplantation was used to treat one case of vesicular keratopathy. It can reduce the injury of graft endothelium, and the requirement of anterior chamber space is low. It was reported in the past that the incidence of rejection in endothelial transplantation was low. In this report, endothelial rejection occurred 4 and a half months after operation. It is suggested that the patients with this type of operation should continue to use drugs to prevent rejection for a long period of time. The long-term effect needs further observation.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.65

【相似文献】