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題名:DEEP ANTERIOR LAMELLAR KERATOPLASTY IN THE EARLY PHASE OF LEARNING CURVE     (20點)
前深層角膜移植的初期學習歷程
著者:Sheng-Chi Yang(楊勝吉) ;Sung-Huei Tseng(曾順輝)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:deep anterior lamellar keratoplasty ; learning curve ; microperforation ; Descemet membrane detachment
刊名:中華民國眼科醫學會雜誌
卷期:49卷4期(2010.12)
頁碼:542-551
語言:英語
摘要: 中文摘要PDF ; 英文摘要PDF

目的:探討角膜移植醫師在前深層角膜移植手術 的初期學習歷程。 設計:回溯性介入性病例分析。 方法:此研究分析角膜移植醫師,在前深層角膜 移植初期的學習歷程。共16 位病人(16 隻眼睛)接受 此手術, 適應症包括圓錐角膜(8 位病人) ,及中央角 膜癥痕,造成原因分別因戴隱形眼鏡引發綠膜桿菌角 膜潰囑後造成(4 位病人) , 后疹性病毒感染造成(1 位) ,外傷性造成(3 位) 。術式則使用安華大水泡技 術(Angwar's big-bubble)輔以小水泡技術(small-bubble technique) 。我們記錄每位病人術中及術後併發症、 角膜清晰度、最佳視力以及內皮細胞密度。術後追蹤 8 至33 個月, 平均15.8 個月。 結果:病人平均年齡為32 . 1:!::16 . 9 歲(最小17 歲, 最大77 歲) 。術中有五例發生微小角膜破裂, 但是手術都能夠順利繼續進行而無需轉變成全層角膜移 植。術後有四例發生後彈力層(Descemet membrane) 剝離,在前房施打20%的SF6 氣體或空氣後,剝離的 後彈力層皆能重新復位。在本研究結束前,所有移植 的角膜都維持清澈, 無任何排斥或內皮失償的狀況。 排除一例有弱視病人的視力外, 其餘病人的術前最佳 矯正視力(logMAR)平均為0.93 :!::O.48 '而術後進步至 0.60:!:: 0. 52 。內皮細胞平均喪失率為14% '但在術中 有微小角膜破裂的病人,則有較高的內皮細胞喪失率 及發生後彈力層剝落的機會。 結論:在治療角膜基質疾病中,前深層角膜移植 是全層移植外的男類有效選擇。雖然在初期的學習歷 程中,發生術中微小角膜破裂及術後後彈力層剝離的 機會不低, 但適時並適當地處置仍將有不錯的手術成 效。
Objective: To repo 內the early experience of deep anterior lamellar keratoplasty (DALK). Design: Retrospective interventional case series. Methods: We retrospectively reviewed 16 patients (16 eyes) who had undergone DALK in a corneal transplant surgeon's early phase of DALK learning. Preoperative diagnosis included advanced keratoconus (8 eyes) and corneal stromal scars associated with previous contact lens-related keratitis (4 eyes), herpetic keratitis (1 eye), and trauma (3 eyes). DALK was pe 斤。rmed by using Angwar's big-bubble technique, assisted by the small-bubble technique if required. Outcome measures included intraoperative and postoperative complications, graft clarity, postoperative best-corrected visual acuity (BCVA) and corneal endothelial cell density. Results: The mean age of the patients was 32.1 ::!: 16.9 years (range, 17 to 77 years). The mean postoperative follow叫p period was 15.8 months, ranging from 8 to 33 months. Intraoperative microperforation occurred in 5 eyes; however, none required converting DALK to penetrating keratoplasty. Postoperatively, detachment of the Descemet membrane (DM) was observed in 4 patients, and all of them could be successfully reattached after intracameral injection of 20% SF6 or air. By the end of the study, all patients attained a clear graft without rejection or endothelial decompensation. Excluding one patient with amblyopia, the mean preoperative and postoperative BCVA (logMAR) for eyes with a minimum of 8 months of follow叫p were 0.93 ::!: 0.48 and 0.60 ::!: 0.52, respectively. The mean endothelial cell loss was estimated to be 14%. Eyes with intraoperative microperforation tended to have a greater endothelial cell loss and a higher incidence of DM detachment. Conclusion: DALK is a viable alternative to PK for corneal stromal disorders. Although the incidences of intraoperative microperforation and postoperative DM detachment were not low in the early phase of the learning curve, favorable outcome is possible with timely and appropriate management of these complications.


    

本卷期目次
中華民國眼科醫學會雜誌 49卷4期 (2010.12)
治療葡萄膜炎兔疫抑制藥物依實證醫學之使用原則:至2009 年相關文獻回顧第三部份:新一代治療葡萄膜炎之生物製劑/ 張文瑞陳肇寅陳冠任賴旗俊吳為吉王南凱黃奕修
從small incision 到micro incision phacoemulsification──我的個人經驗/ 黃維仁
自費人工水晶體──開業醫師如何避兔和面對不高興的病人/ 潘志勤
白內障手術──瞳孔散不大怎麼辦/ 劉瑞玲
DEEP ANTERIOR LAMELLAR KERATOPLASTY IN THE EARLY PHASE OF LEARNING CURVE/ Sheng-Chi YangSung-Huei Tseng
FIBRIN GLUE-ASSISTED CONJUNCTIVALAUTOGRAFTING IN PTERYGIUM SURGERY/ Yi-Hsun HuangSung-Huei TsengYing-Ting Chen
BEVACIZUMAB PRETREATMENT IN VITRECTOMY FOR SEVERE PROLIFERATIVE DIABETIC RETINOPATHY/ Jia-Kang Wang
CASE-SERIES STUDY OF 23-GAUGE SUTURELESS VITRECTOMY AND 20-GAUGE VITRECTOMY/ Tsong-Chi ChangChing-Chih LiuShiow-Wen LiouChing-Yao TsaiChih-Wei Shih
CLINICAL EXPERIENCES IN BLEPHAROCHALASIS SYNDROME/ Yi-Lin Liaoshih-Ming JungYen-Chang ChuShu-Ya WuYueh-Ju TsaiLih Ma
內斜視手術術後連貫性外斜視之手術結果/ 薛珮吟郭雅慧楊孟玲賴慧群黃鐘瑩高玲玉林耕國鄭涵之
ROSACEA KERATITIS WITH CORNEAL PERFORATION: 2-CASE REPORT/ Yun-Ju ChenI-Jong WangWei-Li ChenFung-Rong HuYu-Chih Hou
EARLY POSTOPERATIVE CAPSULAR BLOCK SYNDROME──A CASE REPORT/ Hsin-Hsing LaiI-Mo Fang
ACUTE POSTCATARACT ENDOPHTHALMITIS CAUSED BY COAGULASE-NEGATIVE STAPHYLOCOCCUS LUGDUNENSIS/ Yow-Jia HuangLung-Kun YehChi-Chun LaiTun-Lu ChenAn-Ning ChaoKuan-Jen Chen
DISINSERTION OF INFERIOR OBLIQUE MUSCLE FOR REPAIR OF ORBITAL FLOOR AND MEDIAL WALL FRACTURE VIA TRANSCARUNCULAR AND INFERIOR FORNICEAL APPROACH──A CASE REPORT/ Shin-Yi ChenYueh-Ju TsaiLih MaShu-Ya WuYen-Chang Chu
PHOTOREFRACTIVE KERATECTOMY TREATMENT FOR MYOPIA AND CONCOMITANT CORNEAL SCAR AFTER FUNGAL KERATITIS/ Ya-Chun ChuangYih-Shiou HwangDavid Hui-Kang MaKen-Kuo LinHung-Chi Jesse Chen
INTRAVITREAL TRIAMCINOLONE FOR PURTSCHER'S RETINOPATHY──A CASE REPORT/ Ying-Ying YangLing YeungLan-Hsin ChuangWan-Chen KuChi-Chin SunKo-Jen Yang
CRYPTOCOCCAL MENINGOENCEPHALITIS : AN ATYPICAL PRESENTATION WITH DIPLOPIA./ Ya-Cheng ChuangChi-Wu ChangChi-Chen LiouMay-Lin peng
 
   
 
   

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