deep lamellar keratoplasty with complete removal of pathological stroma for vision improvement

by:Cleanmo      2020-04-06
Corneal transplant of deep plate layer (DLK)
Vision recovery was performed on 120 eyes with turbid corneal matrix.
DLK is considered an effective way to treat the eyes where the function of the endothelial cells is preserved and there is no epithelial or matrix edema.
The purpose of this study is to evaluate the effectiveness of this treatment.
Methods the matrix was removed, at least in the optical area, and only the posterior tooth embryo membrane was retained.
The donor cornea is complete or almost complete, and the thickness is removed from the posterior tooth membrane, or has reached a thickness of 0.
From the endothelial side 4mm, connected by stitching.
Results after 6 months and above, 113 eyes were observed, with an average vision of 0.
09, the average vision improved to 0 after surgery. 6.
One month after the operation, the Mirror microscope showed an average endothelial cell count of 2225 (SD 659)
/Mm2, the value of 24 months after surgery is 1937 (642)/mm2 (cell loss 13%).
Out of 120 eyes, 47 eyes puncture the posterior dental membrane during surgery (39. 2%)
, But after 12 months, there was no difference in vision or number of endothelial cells between these eyes and those without puncture.
Conclusion there was no endothelial rejection after DLK operation, and the visual acuity recovered well after operation.
DLK allows the endothelial cell count to remain longer compared to penetrating corneal transplants.
In addition, it is expected to be more consistent with the long-term results of DLK.
Materials and methods between May 1988 and April 1995, surgery was performed on 120 eyes of 106 patients at Sugita eye hospital.
The preoperative diagnosis was 40 cases with 47 eyes and cornea bright coma, 20 cases with 22 eyes and 22 eyes-
Like malnutrition in 22 eyes of 19 patients, Granular corneal malnutrition in 7 Eyes of 5 patients, scars after 18 eyes infection in 18 patients, and 4 eyes in 4 patients
There was no corneal epithelial or matrix edema except for one patient.
Preoperative ultrasound measurements in all patients showed that the minimum corneal thickness did not exceed 620 μm.
The age of the patient ranges from 8 to 86 (
Average age 59).
50 males and 56 females.
The donor cornea used is a full-thickness cornea including the endothelial cells of 16 eyes, of which 50 eyes have melted the cornea of the bone-removed omental with a cotton swab, and the corneal thickness is about 0.
Use Barraque\'s cryolathe in 54 eyes, 4mm from the endothelial side.
First, the cornea is drilled through three quarters of its depth, and then a layer of corneal resection is performed.
Trephine with stopper can be used, but it is difficult to cut to the required depth.
Barron vacuum trephine is very well cut and very convenient.
However, as the edge of the blade is tightened, the depth may vary depending on the position.
Plate-layer corneal resection uses a Golf or Paufique knife, paying attention to the same depth as possible.
When the matrix fragments are raised, there will be a white area on the edge of the incision, which is the result of air penetrating between collagen fibers.
The cutting is done in a way that the blade moves, just like touching the area.
Corneal resection of deep plate layer (a)
Dehydroamine matrix collagen fibers were cut down to create a depression and a blunt saline solution of needle 27 was injected at the bottom of the Depression.
The solution penetrates between the collagen, making the collagen White and expanding.
The non-obvious matrix expands and can be safely removed by further spatula stripping.
By doing the moisture layer in this way, it is also possible to determine whether the remaining matrix is close to normal.
Therefore, as shown in Figure 1, the injected solution is evenly distributed in all directions, indicating that the normal structure of the collagen fiber is maintained.
Pathological matrix, uneven distribution of solution, small swelling.
Because the deep matrix fibers are thicker, the solution of a single injection spreads more widely.
When the matrix is close to normal, the moisture layer continues until more swelling is not seen, and the removal of the matrix then stops.
However, for the pathological matrix, the resection must proceed until the decemet membrane is exposed.
Download the new tabDownload figureOpen powerpointFigure 1 Hydrogen delivery.
The solution injected into the normal matrix is evenly distributed in all directions, and the remaining matrix is whitened and expanded. (b)
The spatula layer made a small incision with a golf knife in the remaining substrate, just like checking the depth, and made a fine spatula with a diameter of 0 from the bottom of the incision. 25 mm (Katena K3–2310)
The line is inserted into the matrix.
Once the spatula has made some progress, it will come back and be moved over and over again
Like in different directions (Fig 2).
Slide the Paufique knife or corneal scissors into this opening and remove the matrix.
It is important to gradually remove the matrix to avoid being too deep at any time.
Download the new tabDownload figureOpen powerpointFigure monthly spatula.
A fine spatula inserts a straight line into the hydrogen delayed matrix, then comes back and moves the fan over and over again
In different directions. (c)
The membrane of the post-exposure dental stone in a thinner slice, and when the membrane of the post-dental stone approaches, the anterior chamber pressure causes a slight expansion of the remaining matrix.
The film of desemet is very different from the matrix with fiber structure.
It is a smooth and smooth film, and the difference appears immediately (see Fig 3).
Downloading figureOpen in the film of the new tabDownload powerpoint figure 3 desemet is smooth, uniform, and has a clear difference from the matrix.
The film of the desemet is attached only loosely to the substrate, so the spatula can move horizontally.
If the remaining matrix is raised with a suture clamp, it can be removed on an area about 5mm in diameter with a corneal scissors covering the pupil area.
Puncture is easy to occur at this stage of surgery and requires fine work.
In addition, the film of desemet becomes thicker with age, and may be quite tough in the elderly.
On the contrary, it is thin when it is young and, while elastic, it is easy to break. (d)
If the cement film is punctured during this process and the hole is small, the cement film can be exposed by injecting air into the front room.
If there is a wide range of linear tears and the matrix has been removed to sufficient depth, the removal of the matrix can be abandoned at this time and the suture graft can begin.
Graft was prepared for 54 eyes, and the cornea was prepared from the endothelial side by freezing, with a thickness of about 0.
4mm, frozen before use.
In 50 eyes, a virtual full-thickness graft punched from the endothelial side after removing the desscemet membrane with a cotton swab was used.
For 16 eyes, use a fresh cornea that still has endothelial cells attached.
Postoperative transparency with fresh cornea is faster, but over time the results of frozen and preserved cornea are similar.
One eye uses the cornea that is preserved in glycerin, and this graft becomes very hard, making stitching difficult and causing problems with post-operative transparency.
Results 113 eyes were observed for 6 months and 6 months or more, and the average vision before operation was 0.
09, the average vision improved to 0 after surgery. 6 (Fig 4).
71 out of 113 eyes (62. 8%)
Postoperative correction of vision 0. 5 or better.
There are 12 eyes with corrected vision of 0.
1 or worse, but in 9 of them, there was an abnormality in the retina area.
Figure 4 changes in vision before and after surgery (
Follow-up for more than 6 months and 87 eyes).
Table 1 shows a comparison of visual acuity after five primitive pathologies.
Glue drops
Just like malnutrition shows more severe vision than other diseases (
Particle malnutrition and grid malnutrition; p
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