Endothelial cell loss after descemet stripping with endothelial keratoplasty - Influencing factors and 2-year trend
Endothelial cell loss after descemet stripping with endothelial keratoplasty - Influencing factors and 2-year trend
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DOI：
10.1016/j.ophtha.2007.06.033
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发表时间：
2008-05-01
期刊：
影响因子：
13.7
通讯作者：
Price, Francis W., Jr.
中科院分区：
文献类型：
--
作者：
Price, Marianne O.;Price, Francis W., Jr.
目的：确定后弹力层剥脱联合内皮角膜移植术（DSEK）后早期内皮细胞丢失的相关因素，并记录2年内的细胞丢失情况。设计：横断面和纵向回顾性分析。参与者：216例患者的263只眼，均接受DSEK治疗，术后在同一中心接受检查。通过多变量方差分析对6个月内皮细胞密度（ECD）测量值进行分析，以确定术前、手术和术后显著影响早期细胞丢失的因素。此外，在移植后6、12和24个月纵向比较ECD测量值。主要结果测量：移植后中央ECD。结果：DSEK后6个月平均ECD为2000 +/- 550个细胞/mm（2），代表细胞损失34 +/-18%。与较低的6个月细胞丢失相关的因素是使用单点固定钳，在移植物插入过程中仅在头端压缩供体组织（P = 0.025）和没有任何二次供体再附着手术（P = 0.035）。当DSEK作为联合手术进行时，6个月的细胞损失也显著减少;在联合病例中，移植物通过透明角膜切口插入，而在标准病例中，移植物通过巩膜隧道切口插入，这可能会产生更多的压力。细胞丢失与手动和微型角膜刀供体解剖技术相当（P = 0.91）。术后ECD与供体ECD呈正相关（P
Purpose: To identify factors correlated with early endothelial cell loss after Descemet stripping with endothelial keratoplasty (DSEK) and to document cell loss over a 2-year period.Design: Cross-sectional and longitudinal retrospective analyses.Participants: A series of 263 eyes in 216 patients who were treated with DSEK and were examined at the same center after surgery.Methods: Six-month endothelial cell density (ECD) measurements were analyzed by multivariate analysis of variance to identify preoperative, operative, and postoperative factors that significantly influenced early cell loss. In addition, ECD measurements were compared longitudinally at 6, 12, and 24 months after grafting.Main Outcome Measures: Central ECD after transplantation.Results: Mean ECD was 2000 +/- 550 cells/mm(2) 6 months after DSEK, representing cell loss of 34 +/- 18%. Factors associated with lower 6-month cell loss were use of single-point fixation forceps that compressed the donor tissue only at the tip during graft insertion (P = 0.025) and absence of any secondary donor reattachment procedure (P = 0.035). Six-month cell loss also was significantly less when DSEK was performed as a combined procedure; in combined cases, the graft was inserted through a clear corneal incision, whereas in standard cases, it was inserted through a scleral tunnel incision, which likely exerted more compression. Cell loss was comparable with manual and microkeratome donor dissection techniques (P = 0.91). Postoperative ECD was correlated positively with donor ECD (P