DCD角膜移植术后角膜内皮细胞的变化
Changes of Corneal Endothelial Cells after DCD Corneal Transplantation
-
摘要: 目的 探讨心脏死亡供体器官捐献 (donation after cardiac death, DCD) 来源角膜植片行穿透性角膜移植后角膜内皮细胞变异情况.方法 用角膜内皮显微镜对心脏死亡供体来源角膜植片行穿透性角膜移植191例眼术后角膜植片分别于术后14周;512周;46月;712月行角膜内皮镜检查.结果 (1) 191例患者中有48例患者角膜内皮镜检出, 143例患者角膜内皮镜无法检出, 检出率占25%; (2) 48例患者术后14周、23月、46月及712月的内皮细胞细胞密度 (2271.15±321.47) 个/mm2、 (1971.33±358.18) 个/mm2、 (1826.59±303.92) 个/mm2、及 (1753.14±306.31) 个/mm2.平均细胞面积由术前的 (388.45±95.26) μm增加到术后712月的 (638.63±124.73) , 细胞大小变异系数 (cv值) 由30.15%增加到65.04%, 六角形细胞比例由 (52.59±7.26) %下降到 (40.01±11.35) %.结论 (1) 角膜内皮镜检查对于早期角膜移植术后患者内皮细胞识别率较低, 敏感度差, 角膜移植术后早期内皮镜无法测出结果时可选择共焦显微镜评价观察角膜内皮细胞的变化; (2) 穿透性角膜移植术后供眼角膜内皮细胞密度逐渐减少, 六角形细胞比例渐变小平均细胞面积和cv值均渐增大. (3) DCD角膜移植术后1 a, 尤其是术后3月应加强术后随访, 当发现有早期排斥反应的征象时, 及时进行抗排斥治疗对于减少早期排斥反应尤为重要.
-
关键词:
- 心脏死亡供体器官捐献 (DCD) /
- 穿透性角膜移植 /
- 角膜内皮细胞
Abstract: Objective To study the variation of corneal endothelial cellsafterpenetrating keratoplasty from donation after cardiac death (DCD) .Methods 191 cases of corneal graftwere textedafter penetrating keratoplasty1-4 weeks; 5-12 weeks; 4-6 months; 7-12 months later from donation after cardiac death with corneal endothelial microscope.Results 1.48 patients in 191 cases of patients with corneal endothelial microscopeweredetected, 143 cases of patients could not be detected, the detection rate was 25%;2.48 cases after1-4 weeks, 5-12 weeks, 4-6 monthsand 7-12 months the density of endothelial cells were (2271.15±321.47) mm2, (1971.33±358.18) mm2, (1 826.59±303.92) mm2, (1753.14±306.31) mm2, and the average cell area increased from (388.45 ±95.26) μm to (638.63 ±124.73) μm 7-12 months after operation, cell size variation coefficient (CV value) increased from 30.15% to 65.04%, the proportion of hexagonal cells decreased from 52.59 ±7.26% to 40.01 ±11.35%.Conclusion (1) corneal endothelial endoscopy for early corneal endothelial cells of patients with recognition rate is low, poor sensitivity, confocal microscopy evaluation could be used instead of corneal endothelial microsco when the cornea was edema; (2) Corneal endothelial cell density decreased gradually and the percentage of hexagonal cells was descend and CV value were increased after penetratingkeratoplasty; (3) Follow-up should be strengthened after penetrating keratoplasty from donation after cardiac death (DCD) 1 a later especially three months later, when there were signs of early rejection, timely anti rejection treatment was very important for reducing early rejection. -
[1] [1]PASCOLINI D, MARIOTTI S P.Global estimates of visual impairment.2010[J].Br J Ophthalmol, 2012, 96 (5) :614-618.[1]PASCOLINI D, MARIOTTI S P.Global estimates of visual impairment.2010[J].Br J Ophthalmol, 2012, 96 (5) :614-618. [2]潘志强, 梁庆丰.重视角膜移植手术的供体材料问题[J].中华眼科杂志, 2016, 9 (9) :641-643[2]潘志强, 梁庆丰.重视角膜移植手术的供体材料问题[J].中华眼科杂志, 2016, 9 (9) :641-643 [3]牟彦, 赵敏.世界眼库发展及角膜捐献现状[J].中国实用眼科杂志, 2011, 29 (4) :304-307.[3]牟彦, 赵敏.世界眼库发展及角膜捐献现状[J].中国实用眼科杂志, 2011, 29 (4) :304-307. [4] 中华医学会眼科学分会角膜病学组, 我国角膜移植手术用药专家共识 (2016年) [J].中华眼科杂志, 2016, 52 (10) :733-737.[4]中华医学会眼科学分会角膜病学组, 我国角膜移植手术用药专家共识 (2016年) [J].中华眼科杂志, 2016, 52 (10) :733-737. [5] [5]CAVANAGH H D, JESTER J V, ESSEPIAN J, et al.Confocal microscopy of the living eye[J].CLAO, 1990, 16 (1) :65-73.[5]CAVANAGH H D, JESTER J V, ESSEPIAN J, et al.Confocal microscopy of the living eye[J].CLAO, 1990, 16 (1) :65-73. [6]汪玲, 吴洁, 朱秀萍, 等.角膜共焦显微镜早期诊断兔高危角膜移植排斥反应的价值[J].国际眼科杂志, 2008, 8 (7) :1334-1336.[6]汪玲, 吴洁, 朱秀萍, 等.角膜共焦显微镜早期诊断兔高危角膜移植排斥反应的价值[J].国际眼科杂志, 2008, 8 (7) :1334-1336. [7]李凤鸣.中华眼科学[M].第2版.北京:人民卫生出版社, 2006:1177-1178.[7]李凤鸣.中华眼科学[M].第2版.北京:人民卫生出版社, 2006:1177-1178. [8]王素娟, 张月琴, 李金, 等.生物角膜用于人角膜板层移植术后的临床疗效及激光扫描共焦显微镜动态观察[J].中华实验眼科杂志, 2016, 34 (2) :144-149.[8]王素娟, 张月琴, 李金, 等.生物角膜用于人角膜板层移植术后的临床疗效及激光扫描共焦显微镜动态观察[J].中华实验眼科杂志, 2016, 34 (2) :144-149. [9] 刘家琦, 李凤明, 吴静安, 等.实用眼科学[M].第2版.北京:人民卫生出版社, 2005:250-251.[9]刘家琦, 李凤明, 吴静安, 等.实用眼科学[M].第2版.北京:人民卫生出版社, 2005:250-251. -
点击查看大图
计量
- 文章访问数: 1427
- HTML全文浏览量: 511
- PDF下载量: 55
- 被引次数: 0
下载:
