Effect of incision width on graft survival and endothelial cell loss after Descemet stripping automated endothelial keratoplasty.
Effect of incision width on graft survival and endothelial cell loss after Descemet stripping automated endothelial keratoplasty.
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DOI：
10.1097/ico.0b013e3181c11e5d
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发表时间：
2010-05
期刊：
影响因子：
2.8
通讯作者：
Lass JH
中科院分区：
文献类型：
--
作者：
Price MO;Bidros M;Gorovoy M;Price FW Jr;Benetz BA;Menegay HJ;Debanne SM;Lass JH
评估切口宽度（5.0和3.2 mm）对后弹力层剥脱式自动内皮角膜移植术（DSAEK）后6个月和1年移植物存活和内皮细胞丢失的影响。167例中度风险条件（主要是Fuchs营养不良或人工晶状体角膜水肿）的内皮失代偿受试者由两位经验丰富的外科医生进行DSAEK。将供体折叠并用单点固定钳插入。这项回顾性分析评估了移植物存活率、并发症和内皮细胞损失，这些是根据基线供体和术后6个月和1年中央内皮图像计算的，这些图像由独立的角膜内皮阅读中心评价。两组均未发生一期移植物失效。5.0 mm组和3.2 mm组的1年移植物存活率相当（98% vs. 97%）（P=1.0）。并发症包括移植物脱位、移植物排斥反应和眼内压升高，两组的发生率相似（P ≥ 0.28）。两组均未发生瞳孔阻滞性青光眼。平均基线供体内皮细胞密度没有差异：5.0 mm组为2782个细胞/mm 2（n=64），3.2 mm组为2784个细胞/mm 2（n=103）。5.0 mm和3.2 mm切口组的内皮细胞丢失百分比分别为27±20%（n=55）vs. 40±22%（n=71; 6个月）和31±19%（n=45）vs. 44±22%（n=62; 12个月）（均P<0.001）。DSAEK术后一年，两组的总体移植成功率相当;然而，5.0 mm的切口宽度导致6个月和12个月时内皮细胞损失显著降低。
To assess the effect of incision width (5.0 and 3.2 mm) on graft survival and endothelial cell loss six months and one year after Descemet stripping automated endothelial keratoplasty (DSAEK). One hundred sixty-seven subjects with endothelial decompensation from a moderate-risk condition (principally Fuchs’ dystrophy or pseudophakic corneal edema) underwent DSAEK by two experienced surgeons. The donor was folded over and inserted with single point fixation forceps. This retrospective analysis assessed graft survival, complications, and endothelial cell loss, which was calculated from baseline donor and 6-month and 1-year postoperative central endothelial images evaluated by an independent specular microscopy reading center. No primary graft failures occurred in either group. One-year graft survival rates were comparable (98% vs. 97%) in the 5.0- and 3.2-mm groups, respectively (P=1.0). Complications included graft dislocation, graft rejection episodes, and elevated intraocular pressure and occurred at similar rates in both groups (P ≥ 0.28). Pupillary block glaucoma did not occur in either group. Mean baseline donor endothelial cell density did not differ: 2782 cells/mm2 in the 5.0-mm (n=64) and 2784 cells/mm2 in the 3.2-mm (n=103) groups. Percent endothelial cell loss was 27±20% (n=55) vs. 40±22% (n=71; 6 months) and 31±19% (n=45) vs. 44±22% (n=62; 12 months) in the 5.0-mm and 3.2-mm incision groups, respectively (both P<0.001). One year after DSAEK, overall graft success was comparable for the two groups; however, the 5.0-mm incision width resulted in substantially lower endothelial cell loss at 6 and 12 months.