후층판각막이식술 후 이식편의 부착 및 각막기능의 회복에 관현 연구 = Graft Adhesion and Recovery of Corneal Fuction after Posterior Lamellar Keratoplasty

국문 초록 (Abstract)

목적 : 후부층판각막이식술은 향후 전층각막이식을 대체할 수 있을 것으로 예상되어 최근 많은 연구가 행해지고 있다. 본 연구에서는 무딘절개도를 이용한 후부층판각막이식술후 각막기능의 회복과 이식편의 부착기전을 알아보고자 하였다.
대상과 방법 : 실험동물로 개 8마리의 16안을 대상으로 4마리의 8안을 공여안으로 하고 다른 4마리의 8안을 수여안으로 하여 후부층판각막이식술을 시행하고 8주간 각막두께를 측정하고, 세극등현미경 및 경면현미경 관찰로 임상적인 성공 여부를 알아보고, 안구를 적출하여 수술 부위의 조직을 광학현미경, 형광현미경과 전자현미경을 이용하여 관찰하였다.
결과 : 수술 후 시간이 경과함에 따라 각막 혼탁과 부종은 서서히 감소하였으나 수술 후 8주에도 경한 각막혼탁을 보였고, 경면현미경관찰에서 각막내피의 모양과 크기가 점차적으로 회복되었다. 전체 8안중 2안에서 활성화된 각막간질세포와 수여각막과 이식편사이의 콜라겐 섬유조직의 섞임이나 변형 및 방향의 변화가 보였으나 8안중 6안에서는 활성화되지 않은 각막간질세포와 후부각막간질의 콜라겐섬유의 방향이 나란히 배열된 소견을 보였으며 이식안 전체에서 수술 후 8주째까지 완전한 창상치유를 보이는 각막은 관찰할 수 없었고 이식면에 새로운 콜라겐 섬유가 형성되거나 유착에 관여하는 물질이 침착되는 소견은 없었다.
결론 : 무딘절개도를 이용한 후부층판각막이식술에서 이식절편의 해부학적 안정성은 불완전한 상처치유과정과 각막내피세포의 회복에 의해 유지될 것으로 사료된다.

다국어 초록 (Multilingual Abstract)

Purpose: Posterior lamella keratoplasty has been described as a new procedure to treat corneal conditions involving endothelial dysfunction by selective transplantation of only the posterior corneal tissue composed of the endothelium, Descemet membrane, and posterior stroma. This study has been conducted to evaluate the recovery of endothelial function and adhesion mechanism of transplanted posterior corneal tissue to the donor stroma after posterior lamella keratoplasty.
Methods: Dog corneal endothelium and posterior stroma were transplanted to recipient dog cornea stripped of endothelium and posterior stroma. The recovery of endothelial function and corneal thickness were measured by specular microscopy; pachymetry and slit lamp examination were done immediately after posterior lamella keratoplasty and at 1, 2, 4, 8 weeks post-operative. Eight weeks after operation, enucleation was performed and the histopathologic changes in the transplanted area of enucleated eyes were examined by light microscopy, fluorescent microscopy, and electron microscopy.
Results: Corneal thickness, endothelial function, and corneal transparency were recovered by the end of experiment. The newly produced collagen fibrils were absent at the corneal posterior flap and anterior stromal bed interface. The collagen fibrils adjacent to the flap interface were irregularly arranged and morphologically transformed in some cases (2 of 8 cases) and were linearly arranged in a parallel manner in others (6 of 8 cases).
Conclusions: It can be suggested that the stability of transplanted posterior corneal flap is maintained by incomplete wound healing and recovery of corneal endothelial function.

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