植床点定位法降低深板层角膜移植后散光.doc
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植床四点定位法降低深板层角膜移植后散光★◆
王 鑫1,王 珂1,吴彦超1,马利肖1,郭秀瑾2 (1邢台市眼科医院,河北省眼科研究所,河北省眼科学重点实验室,河北省邢台市 054001;
文章亮点:
1 实验创新性的提出深板层角膜移植技术,移植方法先进,并发症少,降低了手术成本,拓展了传统深板层角膜移植的适应证,适用于各期圆锥角膜病的治疗,比传统深板层角膜移植效果更好,尤其增强了对圆锥角膜病的治疗效果。
2改造技术的特点是用1 mL注射器针头边插入角膜基质之间的空隙,边注入滤过空气,在全植床范围内逐渐分离角膜基质与后弹力膜;适用于各期圆锥角膜病的治疗,包括急性期圆锥角膜及瘢痕期圆锥角膜,可以在中央6 mm范围内暴露角膜后弹力层。与其他的深板层角膜移植技术相比,角膜基质残留更少,角膜植片与植床对合处更平整,更有利于角膜移植后散光的控制;同时应用冰冻甘油干燥保存的角膜供体,术中撕除供体角膜后弹力层,进一步避免了内皮型排斥反应的发生。
关键词:
器官移植;组织移植;植床四点定位;角膜地形图;散光;深板层角膜移植
主题词:
角膜移植;圆锥角膜;角膜移植术, 穿透性;散光;眼内压;青光眼
摘要
背景:深板层角膜移植已广泛应用于圆锥角膜的治疗,不但能够达到与穿透性角膜移植术同样的增视效果,且具有移植后排斥反应发生率低等优点。
目的:探讨采用植床四点定位法,降低深板层角膜移植后散光度的效果。
方法:回顾性分析行深板层角膜移植的圆锥角膜病例50例(50眼),分别在移植中采用植床四点定位法25例(25眼)和直接剖切植床即未采用植床四点定位法25例(25眼),对比观察两组患者治疗后散光度及角膜地形图模拟角膜镜度数。
结果与结论:移植后随访6-12个月,平均8.3个月。两组患者无角膜植片排斥反应、继发感染、继发性青光眼等发生。采用植床四点定位法,治疗后患者散光度及角膜地形图模拟角膜镜度数均较未采用四点定位降低。深板层角膜移植术中采用植床四点定位法能够有效地减少因眼内压下降、眼球变形、植床扭曲造成的移植后散光。
Four-point fixation contributes to decreased astigmatism after deep lamellar keratoplasty
Wang Xin1, Wang Ke1, Wu Yan-chao1, Ma Li-xiao1, Guo Xiu-jin2 (1Xingtai Eye Hospital, Xingtai 054001, Hebei Province, China; 2Excimer Laser Chamber, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China)
Abstract
BACKGROUND: Deep lamellar keratoplasty has been widely used in the surgical treatment of keratoconus, which can increase the visual acuity similar to penetrating keratoplasty and has a low incidence of graft rejection.
OBJECTIVE: To explore whether four-point fixation can effectively reduce postoperative astigmatism after deep lamellar keratoplasty.
METHODS: A retrospective analysis was performed in 50 patients (50 eyes) with keratoconus who received deep lamellar keratoplasty. Intraoperative four-point fixation was performed in 25 cases (25 eyes) and direct cutting of the planting bed in another 25 cases (25 eyes). Postoperative astigmatism and simulated keratoscopy reading were compared between two groups.
RESULTS AND CONCLUSION: All the patients were followed up for 6-12 months,
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