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目的用角膜内皮显微镜对穿透性角膜移植的供眼及术后移植片定期进行内皮细胞摄相观察,探讨供眼角膜内皮细胞的变异情况以及影响其变异的因素。方法选择做穿透性角膜移植的15例病人,用角膜内皮显微镜对术前供眼及术后植片进行定期内皮细胞密度、平均细胞面积、细胞大小变异系数(CV值)及细胞形态方面检查分析。结果(1)术后2～6周、3～6个月、7～11个月及1～1.5年的内皮细胞丧失率分别为12.17%、21.91%、26.55%及29.28%。(2)供眼角膜内皮细胞的平均细胞面积由术前的457.06μm2逐渐增加到术后1～1.5年的646.34μm2,CV值由52.42%增加到62.32%。(3)供眼六角形内皮细胞的比率由术前的41.76%下降到术后1～1.5年的28.08%。结论穿透性角膜移植术后供眼角膜内皮细胞密度逐渐减少,细胞丧失率逐渐增大,术后3～6个月增大最明显,7～11个月变化较小,趋于稳定。平均细胞面积及细胞大小变异系数均逐渐增大。标准的六角形细胞比例则逐渐变小,非六角形细胞的比例相应增大。穿透性角膜移植术后,植片均能透明愈合,且角膜厚度在正常范围内,并获得良好视力,因此其是使角膜病失明患者复明的重要手段。
Objective To observe the changes of corneal endothelial cells and the factors that affect the variation of corneal endothelial cells by using corneal endothelium microscope. Methods Fifteen patients who underwent penetrating keratoplasty were examined by corneal endothelial microscopy for the regular endothelial cell density, average cell area, coefficient of variation (CV) and cell morphology of preoperative ophthalmic and postoperative grafts analysis. Results (1) The rates of endothelial cell loss at 2 to 6 weeks, 3 to 6 months, 7 to 11 months and 1 to 1.5 years after operation were 12.17%, 21.91%, 26.55% and 29.28%, respectively. (2) The average cell area of corneal endothelial cells increased from 457.06μm2 preoperatively to 646.34μm2 from 1 to 1.5 years after operation, and the CV value increased from 52.42% to 62.32%. (3) The ratio of corneal endothelial cells decreased from 41.76% before surgery to 28.08% after 1 ~ 1.5 years. Conclusions After penetrating keratoplasty, the density of corneal endothelial cells gradually decreases, the rate of cell loss gradually increases, and the most obvious increase occurs 3-6 months after operation. The changes in 7 ~ 11 months are smaller and tend to be stable. The average cell area and cell size coefficient of variation were gradually increased. The proportion of standard hexagonal cells is gradually smaller, a corresponding increase in the proportion of non-hexagonal cells. After penetrating keratoplasty, the implants are transparent and healed, and the corneal thickness is within the normal range and good visual acuity, so it is an important means to make patients with corneal blindness complicated.