Graft survival and endothelial outcomes in the new era of endothelial keratoplasty.
Graft survival and endothelial outcomes in the new era of endothelial keratoplasty.
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DOI：
10.1016/j.exer.2011.05.013
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发表时间：
2012-02
影响因子：
3.4
通讯作者：
Patel, Sanjay V.
中科院分区：
文献类型：
--
作者：
Patel, Sanjay V.
关键词：
角膜内皮细胞在体内不能充分增殖以使内皮再生，因此导致视力差和不适的角膜内皮疾病需要通过移植尸体供体角膜内皮细胞来治疗。任何角膜移植手术的两个主要目标是恢复视力和通过维持健康的供体内皮细胞密度来促进供体角膜的寿命。在过去的十年中，内皮疾病的手术治疗已迅速发展为内皮角膜移植术，或选择性组织移植，远离全层穿透性角膜移植术（PK）。虽然内皮角膜移植术在视力结果和较小切口方面优于PK，但对脆弱供体组织的新手术操作会导致显著的供体内皮细胞损伤。因此，与PK后相比，在后弹力层剥脱内皮角膜移植术（DSEK）后的第一个月期间供体内皮细胞损失要高得多，并且原发性（或更适当地，医源性）移植失败率5%仍然高得不可接受。然而，DSEK后6个月后内皮细胞损失率迅速降低，因此DSEK后5年的内皮细胞损失似乎低于PK后5年的内皮细胞损失。在没有原发性（医源性）移植物衰竭的情况下，DSEK后5年的移植物存活率与PK后相似。鉴于DSEK的长期内皮结局前景看好，对优化视力结局的追求激发了人们对后弹力层内皮角膜移植术（DMEK）的兴趣。虽然DMEK后的早期结果表明比DSEK后更好的视力结果，但该技术需要简化，并且长期结果必须显示在视力，内皮细胞损失和移植物存活方面优于DSEK。DMEK还具有高的原发性（医源性）移植物失败率，并且当DMEK移植物的制备不成功时，会发生额外的供体组织浪费。本文综述了内皮角膜移植技术和相关的内皮结果。
Corneal endothelial cells do not proliferative in vivo sufficiently to enable endothelial regeneration, and thus diseases of the corneal endothelium, which cause poor vision and discomfort, require treatment by transplantation of cadaveric donor corneal endothelial cells. The two major goals of any corneal transplant procedure are to restore vision and to promote longevity of the donor cornea by maintaining a healthy donor endothelial cell density. Over the last decade, the surgical treatment for endothelial disease has rapidly evolved toward endothelial keratoplasty, or selective tissue transplantation, and away from full-thickness penetrating keratoplasty (PK). While endothelial keratoplasty offers distinct advantages over PK in terms of visual outcomes and a smaller incision, the new surgical manipulations of the fragile donor tissue cause significant donor endothelial cell trauma. As a result, donor endothelial cell loss is much higher during the first month after Descemet stripping endothelial keratoplasty (DSEK) compared to after PK, and the primary (or more appropriately, iatrogenic) graft failure rate of 5% remains unacceptably high. Nevertheless, the rate of endothelial cell loss rapidly decreases beyond 6 months after DSEK, and thus endothelial cell loss at 5 years after DSEK appears to be lower than that at 5 years after PK. In the absence of primary (iatrogenic) graft failure, graft survival through 5 years after DSEK is similar to that after PK. Given the promising longer-term endothelial outcomes of DSEK, the quest for optimizing the visual outcomes has spurred interest in Descemet membrane endothelial keratoplasty (DMEK). While early results after DMEK suggest better visual outcomes than after DSEK, the technique needs to be simplified, and longer-term outcomes must show an advantage over DSEK with respect to vision, endothelial cell loss, and graft survival. DMEK also has a high rate of primary (iatrogenic) graft failure, and additional donor tissue wastage occurs when preparation of DMEK grafts is unsuccessful. This review discusses endothelial keratoplasty techniques and the associated endothelial outcomes.
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影响因子：
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作者：
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通讯作者：
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