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Abstract: Objective: To evaluate the clinical efficacy of peripheral deep anterior lamellar keratoplasty (DALK) using a cryopreserved donor cornea for terrien’s marginal degeneration (TMD). Methods: Thirty-one eyes of 27 patients with TMD underwent peripheral DALK using cryopreserved donor corneas. According to the distance between the inner edge of the lesion and the limbus, a ring-shaped or D-shaped DALK was performed. All grafts were stored at −20 °C. Cryopreserved corneoscleral rims were prepared for ring-shaped grafts and cryopreserved whole eyeballs were prepared for D-shaped grafts. The general conditions, intraoperative performance, postoperative corneal reconstruction, astigmatism, best corrected visual acuity (BCVA), and various complications were analyzed. Results: Ring-shaped DALK was performed in 28 eyes and D-shaped DALK was performed in 3 eyes. Postoperative follow-up time was (28.4±24.8) months. There was evidence of inflammation before surgery in 12 eyes (38.7%) and intraoperative perforation occurred in 13 eyes (41.9%). The corneal structures of all eyes were reconstructed. Postoperative astigmatism and BCVA showed improvement (both P=0.00) except for cases that underwent D-shaped DALK. Ten eyes (32.2%) developed transient ocular hypertension and one eye (3.2%) developed secondary glaucoma. No primary disease recurrence or corneal allograft rejection was observed. Conclusions: Peripheral DALK for TMD using cryopreserved donor tissue is an effective technique that eliminates rejection and extends the use of donor eyes. Inflammatory history or intraoperative perforation has no adverse effect on graft recovery. However, D-shaped DALK did not achieve good visual outcomes.

冰冻保存供体的周边深板层角膜移植治疗Terrien's角膜变性的临床疗效

观察采用冰冻保存供体的周边深板层角膜移植治疗Terrien's角膜变性（TMD）的临床疗效，探讨TMD的最佳手术治疗方式。 供体角膜为冰冻保存，其中部分为中央角膜移植术后剩余的角巩膜环，并改进传统的手术方法。采用周边深板层角膜移植，既充分利用和节约供体，避免排斥反应，又简化了手术操作过程，有效地恢复了眼球完整性和提高术后视力。 研究对象为1998年6月至2012年12月期间在浙江大学医学院附属邵逸夫医院眼科中心进行周边深板层角膜移植术的27例TMD病人的31只眼。根据病变范围和大小，分别进行环形深板层角膜移植和D形深板层角膜移植。所有植片均于-20°C冰冻保存，冰冻保存的角巩膜环植片用于环形深板层角膜移植，冰冻保存的整个眼球用于D形深板层角膜移植。对所有术眼的病例资料、视频及影像学检查进行回顾性分析，记录并总结患者的一般情况、术中表现、术后角膜结构的变化、屈光及视力的变化及术后并发症等。 采用冰冻保存供体的周边深板层角膜移植治疗TMD可以有效地恢复角膜结构的完整性且能长期维持（图3和4）。术后随访过程未发现免疫排斥反应，环形深板层角膜移植术后视力较前明显提高，而3例（100%）D形深板层角膜移植术后散光及视力均不提高（表1和2）。术前炎症及术中穿孔并不影响术后最终结果。
Terrien's角膜变性；周边深板层角膜移植；冰冻保存

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