In vivo laser confocal microscopy after Descemet stripping with automated endothelial keratoplasty
In vivo laser confocal microscopy after Descemet stripping with automated endothelial keratoplasty
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DOI：
10.1016/j.ajo.2008.02.009
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发表时间：
2008-06-01
影响因子：
4.2
通讯作者：
Sugiyama, Kazuhisa
中科院分区：
文献类型：
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作者：
Kobayashi, Akira;Mawatari, Yoshiro;Sugiyama, Kazuhisa
目的：用激光共聚焦显微镜观察大疱性角膜病变患者Descemet剥离自动内皮角膜移植术（DSAEK）前后的体内角膜变化。设计：单中心、前瞻性、比较临床研究。方法：7例大疱性角膜病变患者（2男5女，平均年龄68.9岁，59 - 78岁）行DSAEK手术。在DSAEK前、DSAEK后1个月、3个月和6个月进行激光共聚焦显微镜检查。对选定的图像进行定性和定量评价，以确定雾霾程度和沉积物密度。结果：术前所有患者均见角膜上皮水肿、上皮下混浊、角质细胞呈蜂窝状，间质中可见细小针状物质。DSAEK后，在所有五个可测量的病例中观察到上皮下雾，供体，受体界面雾和界面颗粒；术后雾霾、颗粒减少，均有统计学意义（P < 0.05）。结论：体内激光共聚焦显微镜能够以高分辨率识别DSAEK术后亚临床角膜异常。为了充分了解DSAEK术后的长期角膜基质变化，以及原有角膜基质病变是否可逆，需要对大量患者进行进一步的研究，并在DSAEK术后进行长期随访。
PURPOSE: To investigate in vivo corneal changes in patients with bullous keratopathies before and after Descemet stripping with automated endothelial keratoplasty (DSAEK) using laser confocal microscopy.DESIGN: Single-center, prospective, comparative clinical study.METHODS: Seven patients (two men, five women; mean age, 68.9 years; range, 59 to 78) with bullous keratopathies who underwent DSAEK enrolled in this study. Laser confocal microscopy was performed before and one, three, and six months after DSAEK. Selected images were evaluated qualitatively and quantitatively for degree of haze and density of deposits.RESULTS: Preoperatively, corneal epithelial edema, subepithelial haze, keratocytes in a honeycomb pattern, and tiny needle,shaped materials in the stroma were observed in all patients. After DSAEK, subepithelial haze, donor,recipient interface haze, and interface particles were observed in all five measurable cases; postoperative haze and particles decreased statistically significantly (P < .05) over follow,up.CONCLUSIONS: In vivo laser confocal microscopy is capable of identifying subclinical corneal abnormality after DSAEK with high resolution. Further studies in a large number of patients and long-term follow-up after DSAEK using this device are needed to fully understand long-term corneal stromal changes after DSAEK and whether the preexisting corneal stromal pathologies are reversible.