深板层角膜移植术后白内障手术的临床研究

Cataract extraction and intraocular lens implantation after deep anterior lamellar keratoplasty

关键词:  深板层角膜移植术  晶体超声乳化术  角膜内皮细胞密度  角膜源性散光  人工晶体屈光力计算

Key words:  deep anterior lamellar keratoplasty  phacoemulsification  endothelial cell density  corneal astigmatism  intraocular lens power calculation

摘要:

目的 探讨深板层角膜移植术（deep anterior lamellar keratoplasty, DALK）后白内障手术治疗的安全性和有效性。方法 纳入DALK术后行白内障超声乳化联合人工晶体植入术患者34例（34只眼）为DALK组，单纯老年性白内障手术患者35例（35眼）为对照组。以角膜地形图仪测量角膜源性散光(corneal astigmatism, CA)，共聚焦显微镜测量角膜内皮细胞密度（endothelial cell density, ECD）、平均角膜内皮细胞面积（average cell area, ACA），眼前节光学相干断层扫描仪测量中央3mm角膜厚度（central corneal thickness, CCT）及前房深度(anterior chamber depth, ACD)；选择性联合散光性角膜切开术。比较两组术前，术后1d、1周、1个月、12个月裸眼视力(uncorrected visual acuity, UCVA)、最佳矫正视力(best corrected visual acuity, BCVA)、综合性散光(astigmatism, A)、CA、ECD、ACA、CCT以及ACD。结果所有手术均顺利实施，随访期(13.1±1.5)个月。DALK组和对照组术前UCVA、BCVA、CCT、ACD差异无统计学意义，A、CA、ECD、ACA差异有统计学意义。术后12个月，两组的UCVA和BCVA均明显提高，DALK组提高幅度不如对照组，差异有统计学意义（P<0.05）;两组的A、CA和ECD均较术前减少，DALK组较对照组较少明显，差异有统计学意义（P<0.05）；两组的ACA均较术前增加，DALK组的增加幅度大于对照组（P<0.05）；两组ACD均较术前增大（P<0.05），CCT较术前无明显变化（P>0.05）。结论 DALK术后，进行白内障手术应注重角膜源性散光矫正、角膜内皮细胞及角膜植片保护，以提高安全性和有效性。

Abstract:

Objective To evaluate the safety and efficacy of cataract extraction and intraocular lens implantation after deep anterior lamellar keratoplasty (DALK). Methods Thirty-four patients（34 eyes）with cataract were treated with phacoemulsification and intraocular lens implantation (IOL) after DALK (DALK group)，whereas 35 patients（35 eyes）with simple senile cataract undergoing phacoemulsification and IOL served as control group. Corneal astigmatism was measured with corneal topographic map. Endothelial cell density（ECD）and average cell area (ACA) were obtained with confocal microscopy. Central corneal thickness（3mm CCT）and anterior chamber depth（ACD） were analyzed by anterior segment optical coherence tomography（AS-OCT）. Patient with corneal astigmatism>1.5D underwent astigmatic keratotomy (AK) during phacoemulsification and IOL implantation. Results All the operations were performed successfully and patients were followed-up for （13.1±1.5） months. There was no significant differences in UCVA, BCVA, CCT and ACD between DALK group and control group before operation, while there were significant differences in preoperative A, CA, ECD, ACA between two groups. Twelve months after the surgery, UCVA and BCVA were significantly improved in both groups, but the improvement was more marked in control group (P<0.05). The A, CA and ECD decreased after surgery in both groups, while the decrease was more marked in DALK group (P<0.05). The ACA was increased in both groups after surgery，the degree of increase in DALK group was more marked than that in control group (P<0.05).The ACD of the two groups increased after surgery(P<0.05). There was no significant difference in CCT before and 12 months after surgery in two groups(P>0.05). Conclusion For patients undergoing cataract extraction and IOL after DALK, more attentions should be paid to corneal astigmatism correction and protection of ECD and corneal graft during the surgery.