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目的探讨圆锥角膜行穿透性角膜移植(PK)术后角膜植片内皮慢性失功的临床特点。设计回顾性病例系列。研究对象圆锥角膜患者PK术后角膜植片内皮慢性失功148例(163眼)。方法所有患者实施PK术,采用非接触式角膜内皮显微镜、A型超声测厚仪和眼前节OCT扫描系统对角膜植片进行评价。主要指标中央角膜内皮细胞密度(ECD)、六边形细胞百分率、内皮细胞丢失率、内皮细胞形态、中央角膜厚度(CCT)及最佳矫正视力。结果PK术后3年内患者植片ECD呈下降趋势,内皮细胞年丢失率为14.2%±10.9%。术后1.5年较术后1年的ECD有明显下降(P=0.002)。术后不同时间点的植片内皮六边形细胞百分率均在50%以上,CCT在500μm以上,各组间比较无统计学差异(P=0.869)。PK术后5年以上复查,患者角膜植片ECD仍呈下降趋势,但个体差异性较大,多数患者的六边形细胞百分率仍在50%以上,内皮细胞面积增大是局部性的,CCT保持在500μm以上。150例未发生排斥的角膜植片除2例发生植片混浊外,其余均保持透明,患者术后最佳矫正视力提高。结论ECD的超生理下降和局部内皮细胞面积增大是PK术后角膜植片内皮慢性失功的主要临床表现。内皮慢性失功的发展存在个体差异性,且在同一个体不同时期发展程度亦有不同。
Objective To investigate the clinical features of corneal graft endothelial dysfunction after penetrating keratoplasty (PK). Design retrospective case series. The study included 148 patients (163 eyes) with chronic corneal endothelial dysfunction after PK surgery. Methods All patients underwent PK surgery. Non-contact corneal endothelial microscopy, A-type ultrasound thickness gauge and anterior segment OCT scanning system were used to evaluate the corneal graft. The main indicators of central corneal endothelial cell density (ECD), hexagonal cell percentage, endothelial cell loss rate, endothelial cell morphology, central corneal thickness (CCT) and best corrected visual acuity. Results In 3 years after operation, the ECD of the patients showed a decreasing trend and the annual loss rate of endothelial cells was 14.2% ± 10.9%. ECD was significantly decreased 1.5 years after surgery compared with 1 year after operation (P = 0.002). The percentage of hexagonal cells in the graft at different time points was above 50% and the CCT was above 500 μm. There was no significant difference between the groups (P = 0.869). PK examination more than 5 years after surgery, the corneal graft ECD still showed a downward trend, but the individual differences are large, the majority of patients with hexagonal cell percentage is still above 50%, endothelial cell area is localized, CCT Keep it above 500μm. 150 cases of non-rejection of corneal grafts in addition to 2 cases of opacification occurred, the rest remained transparent, the best postoperative corrected visual acuity improved. Conclusion The decrease of ECD and the increase of the area of endothelial cells are the main clinical manifestations of corneal graft endothelial dysfunction after PK surgery. There are individual differences in the development of endothelial dysfunction, and in different stages of the same individual development is also different.