摘要目的 应用前节OCT (AS-OCT)研究不撕除后弹力层的角膜内皮移植术(nDSEK)术后角膜厚度,角膜结构功能的改变.方法 回顾性临床研究.收集2007年9月至2011年9月在厦门大学附属厦门眼科中心行nDSEK的20例的角膜内皮病变患者(男9例,女11例),平均年龄(57±20)岁.采用裂隙灯显微镜、前节OCT分别在术前,术后第7天及术后第1、3、6、12、24、36个月,对角膜形态进行连续对比观察.观察的指标包括:角膜中央厚度(包括植床和角膜内皮植片),板层积液以及植片移位等情况.结果 平均随访(30±9)个月,所有患者角膜内皮植片与受体内皮面贴附良好.前节OCT显示20例患者术前角膜中央厚度平均值为:(679±124) μm,术后1周角膜中央平均厚度达(1012±124)μm,角膜植片平均厚度为(208±42) μm,在术后1周到术后3个月角膜厚度明显下降.角膜厚度的改变与内皮细胞功能的恢复有关.在nDSEK术后l周至1个月角膜厚度明显降低,变化速率为6.3 μm/d,术后1～3个月(30天)降低至1.6 μm/d,3～12个月为5.4 μm/月c内皮植片在术后1个月厚度降低明显,1.5μm/天,1个月后植片厚度保持稳定.结论 nDSEK术后角膜内皮功能恢复快,角膜厚度在术后1个月明显降低,3个月后趋于稳定.前节OCT可有效评估nDSEK术后植片内皮细胞功能恢复情况及植床和植片位置关系.

abstractsObjective To evaluate the thickness of cornea and the function of cornea and graft with AS-OCT after non-descemet stripping endothelial keratoplasty.Methods Single-center,prospective,no comparative,interventional case series.All 20 patients,from September 2007 to September 2011 (9 male,11 female) were treated with non-DSEK for bullous keratoplasty,endothelial dysfunction and iridoCorneal endothelial syndrome (ICE) in Xiamen eye center affiliated to Xiamen university.Central corneal thickness,interface fluid and dislocation of graft were measured with AS-OCT during the follow up of 36 months containing preoperative 7 days and 1,3,6,12,24,and 36 months after operation.Results Preoperative average central corneal thickness (CCT) was 718um.From 7 days to 1 month CCT changed significantly.As known the dynamics of CCT was correlated with the change of recipient and graft.Cornea decreased at speed of 10.4um/day within the first week and 5.7um/day during the first month postoperative.During 1 and 36 months the cornea was more stable with only a trend toward further decrease,at speed of 5.6um/month.Conclusions Corneal thickness has changed notably since the 1 month and turned more stable since the 3rd month.AS-OCT can monitor cornea dynamics quantitatively and tell the recovery of endothlieal cell.