Visual Outcomes of Repeat Versus Primary Descemet Stripping Automated Endothelial Keratoplasty—A Paired Comparison
Visual Outcomes of Repeat Versus Primary Descemet Stripping Automated Endothelial Keratoplasty—A Paired Comparison
复制标题
重复与初次后弹力层剥离自动化内皮角膜移植术的视觉结果——配对比较
作者：
Y. Nahum;M. Mimouni;Silvana Madi;M. Busin
目的：比较再次后弹力层剥脱自动角膜内皮移植术（DSAEK）与初次DSAEK的效果。材料与方法：这项回顾性研究包括2005年1月至2015年6月期间在Villa Serena-Villa Igea Private Hospitals（Forlavia，意大利）进行初次DSAEK后接受一次或多次重复DSAEK手术的所有连续眼睛。对初次和第二次DSAEK的结局进行配对比较。主要结果指标包括最佳记录的最佳视力矫正视力（BSCVA）、术后内皮细胞丢失（ECL）和屈光不正。结果：在1413例手术中，51只眼纳入最终分析。原发性DSAEK的适应症包括人工晶状体大泡性角膜病变（n = 21）、Fuchs内皮营养不良（n = 20）、穿透性角膜移植术失败（n = 9）和创伤（n = 1）。重复DSAEK的适应症为缓慢进展的ECL（n = 35）、内皮排斥反应（n = 15）和宿主-移植物界面异常（n = 1）。两组之间的术前BSCVA（最小分辨角对数1.23 ± 0.8 vs. 1.38 ± 0.6，P = 0.29）和最佳术后BSCVA（最小分辨角对数0.32 ± 0.44 vs. 0.34 ± 0.49，P = 0.70）无显著差异。初次和重复DSAEK在1年（46% ± 16% vs. 40% ± 18%，P = 0.22）和2年（50% ± 18% vs. 44% ± 2%，P = 0.33）时的ECL也相似。两组之间的平均术后等效球镜无显著差异（−0.01 ± 1.9 vs. −0.5 ± 1.6，P = 0.08），绝对屈光不正也无显著差异（分别为1.6 ± 1 vs. 1.8 ± 1.2，P = 0.17）。结论：初次DSAEK移植失败后，后续DSAEK可产生与初次DSAEK相当的视力结局和ECL率。
Purpose: To compare the results of repeat Descemet stripping automated endothelial keratoplasty (DSAEK) with those of primary DSAEK. Materials and Methods: This retrospective study consisted of all consecutive eyes that underwent one or more repeat DSAEK surgeries after primary DSAEK performed at Villa Serena–Villa Igea Private Hospitals (Forlì, Italy) between January 2005 and June 2015. A paired comparison between the outcomes of primary and the second DSAEK was performed. Main outcome measures included best recorded best spectacle-corrected visual acuity (BSCVA), postoperative endothelial cell loss (ECL), and refractive error. Results: Of 1413 procedures, 51 eyes were included in the final analysis. Indications for primary DSAEK included pseudophakic bullous keratopathy (n = 21), Fuchs endothelial dystrophy (n = 20), failed penetrating keratoplasty (n = 9), and trauma (n = 1). Indications for repeat DSAEK were slowly progressive ECL (n = 35), endothelial rejection (n = 15), and host–graft interface abnormalities (n = 1). Preoperative BSCVA (logarithm of the minimum angle of resolution 1.23 ± 0.8 vs. 1.38 ± 0.6, P = 0.29) and best postoperative BSCVA (logarithm of the minimum angle of resolution 0.32 ± 0.44 vs. 0.34 ± 0.49, P = 0.70) did not differ significantly between the 2 groups. ECLs for primary and repeat DSAEK at 1 (46% ± 16% vs. 40% ± 18%, P = 0.22) and 2 years (50% ± 18% vs. 44% ± 2%, P = 0.33) were also similar. The mean postoperative spherical equivalent did not differ significantly between the 2 groups (−0.01 ± 1.9 vs. −0.5 ± 1.6, P = 0.08) nor did the absolute astigmatic error (1.6 ± 1 vs. 1.8 ± 1.2, respectively, P = 0.17). Conclusions: After the failure of a primary DSAEK graft, a subsequent DSAEK can yield visual outcomes and ECL rates that are comparable with those of primary DSAEK.