Descemet's stripping automated endothelial keratoplasty: three-year graft and endothelial cell survival compared with penetrating keratoplasty.
Descemet's stripping automated endothelial keratoplasty: three-year graft and endothelial cell survival compared with penetrating keratoplasty.
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DOI：
10.1016/j.ophtha.2012.08.007
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发表时间：
2013-02
期刊：
影响因子：
13.7
通讯作者：
Lass JH
中科院分区：
文献类型：
--
作者：
Price MO;Gorovoy M;Price FW Jr;Benetz BA;Menegay HJ;Lass JH
评估角膜供体研究（CDS）中Descemet剥离自动内皮角膜移植术（DSAEK）与穿透性角膜移植术（PKP）的3年结果。前瞻性、多中心、非随机临床试验。共有173名受试者因中度风险状况（主要是Fuchs营养不良或假性角膜水肿）接受DSAEK，而1101名受试者接受来自CDS的PKP。DSAEK手术由两名经验丰富的外科医生执行，使用与CDS PKP手术相同的供体和相似的受体标准，由68名外科医生执行。Kaplan Meier生存分析评估移植成功。中心内皮细胞密度（ECD）由CDS镜面显微镜辅助研究中使用的阅读中心从基线供体和术后中心内皮图像确定。在DSAEK组和PKP组中，供体和受体的人口统计数据是相当的，除了DSAEK组中Fuchs营养不良病例的比例更高。DSAEK和PKP手术治疗Fuchs营养不良（两者均为96%，P=0.81）或非Fuchs病例（分别为86%对84%，P=0.41）的3年生存率无显著差异。DSAEK和PKP术后3年内移植物失败/再移植物的主要原因分别是移植物免疫排斥反应（0.6%对3.1%）、无排斥反应的内皮失代偿（1.7%对2.1%）、视力或屈光结果不理想（1.7%对0.5%）和感染（0%对1.1%）。DSAEK组3年预测排斥事件发生概率为9%，PKP组为20% （P=0.0005）。在Fuchs的营养不良病例中，DSAEK和PKP的中位3年细胞损失分别为46%和51% (P=0.33)，在非Fuchs的病例中分别为59%和61% （P=0.70）。在3年时，使用较小的DSAEK插入切口与较高的细胞损失相关（分别为60% vs. 3.2 mm和5.0 mm切口的33%，P=0.0007），但移植物存活率无显著差异（P=0.45）。DSAEK和PKP的移植成功率和内皮细胞损失在3年内是相当的。5mm DSAEK切口宽度与3.2 mm切口相比，细胞损失明显减少。
To assess 3-year outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in comparison with penetrating keratoplasty (PKP) from the Cornea Donor Study (CDS). Prospective, multicenter, nonrandomized clinical trial. A total of 173 subjects undergoing DSAEK for a moderate risk condition (principally Fuchs’ dystrophy or pseudophakic corneal edema) compared with 1101 subjects undergoing PKP from the CDS. The DSAEK procedures were performed by two experienced surgeons using the same donor and similar recipient criteria as for the CDS PKP procedures, performed by 68 surgeons. Graft success was assessed by Kaplan Meier survival analysis. Central endothelial cell density (ECD) was determined from baseline donor and postoperative central endothelial images by the reading center used in the CDS Specular Microscopy Ancillary Study. Graft clarity and endothelial cell density The donor and recipient demographics were comparable in the DSAEK and PKP groups, except the proportion of Fuchs’ dystrophy cases was higher in the DSAEK cohort. The 3-year survival rate did not differ significantly between DSAEK and PKP procedures performed for either Fuchs’ dystrophy (96% for both, P=0.81) or non-Fuchs cases (86% vs. 84%, respectively, P=0.41). Principal causes of graft failure/regraft within 3 years after DSAEK and PKP were immunologic graft rejection (0.6% vs. 3.1%), endothelial decompensation in the absence of documented rejection (1.7% vs 2.1%), unsatisfactory visual or refractive outcome (1.7% vs. 0.5%), and infection (0% vs. 1.1%), respectively. The 3-year predicted probability of a rejection episode was 9% with DSAEK vs. 20% with PKP (P=0.0005). The median 3-year cell loss for DSAEK and PKP was 46% and 51%, respectively (P=0.33) in Fuchs’s dystrophy cases, and 59% and 61%, respectively (P=0.70), in the non-Fuchs’ cases. At 3 years, use of a smaller DSAEK insertion incision was associated with significantly higher cell loss (60% vs. 33% for 3.2- and 5.0-mm incisions, respectively, P=0.0007) but not a significant difference in graft survival (P=0.45). The graft success rate and endothelial cell loss were comparable at 3 years for DSAEK and PKP procedures. A 5-mm DSAEK incision width was associated with significantly less cell loss than a 3.2-mm incision.
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影响因子：
13.7
作者：
Gal, Robin L.;Dontchev, Mariya;Verdier, David D.
通讯作者：
Verdier, David D.
影响因子：
2
作者：
Benetz, BA;Gal, RL;Lass, JH
通讯作者：
Lass, JH
影响因子：
2.8
作者：
Stulting RD;Sugar A;Beck R;Belin M;Dontchev M;Feder RS;Gal RL;Holland EJ;Kollman C;Mannis MJ;Price F Jr;Stark W;Verdier DD;Cornea Donor Study Investigator Group
通讯作者：
Cornea Donor Study Investigator Group
影响因子：
13.7
作者：
Lass, JH;Gal, RL;Cotch, MF
通讯作者：
Cotch, MF
影响因子：
13.7
作者：
Lass, Jonathan H.;Gal, Robin L.;Verdier, David D.
通讯作者：
Verdier, David D.