Five-year follow-up outcomes post Descemet’s stripping automated endothelial keratoplasty.
Five-year follow-up outcomes post Descemet’s stripping automated endothelial keratoplasty.
复制标题
后弹力层剥离自动化内皮角膜移植术后的五年随访结果。
DOI：
10.1136/bmjophth-2019-000354
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发表时间：
2020
影响因子：
2.4
通讯作者：
Kinoshita S
中科院分区：
文献类型：
--
作者：
Wakimasu K;Kitazawa K;Kayukawa K;Yokota I;Inatomi T;Hieda O;Sotozono C;Kinoshita S
目的评价后弹力层剥脱式自动角膜内皮移植术（DSAEK）后5年随访期内移植物存活率和内皮细胞密度（ECD）的变化。非FECD大泡性角膜病变（BK）（非FECD）或小梁切除术或管分流术后BK（青光眼伴滤过泡），在2007年8月至2012年1月期间接受DSAEK，术后随访超过5年。排除既往角膜移植、移植物缝合失败、原发性移植物失败、术后眼内炎和眼部感染的患者。然后检查所有接受DSAEK并完成术后随访的患者的移植物存活率和ECD。DSAEK术后5年移植物存活率与临床因素之间的相关性用多变量Logistic回归分析。结果术后5年的总移植物存活率为85%，但青光眼伴滤过泡眼（47%）明显低于FECD眼（100%）或非FECD眼（90%）（p<0.01，log-rank检验）。在FECD、非FECD和青光眼伴滤过泡眼中，术后5年的平均ECD分别为1054个细胞/mm 2、1137个细胞/mm 2和756个细胞/mm 2。多因素Logistic回归分析显示，小梁切除术或管分流术史和术后同种异体移植物排斥反应是DSAEK术后5年移植物存活的负性因素（OR 0.01，95%CI 0.00 ~ 0.10和OR 0.02，95%CI 0.00 ~ 0.33）。结论我们的研究结果表明，在术后5年，DSAEK后的手术结果在小梁切除术或管分流术后的眼睛中较差。试验注册号UMIN 000024891。
ObjectiveTo assess graft survival and endothelial cell density (ECD) over a 5-year follow-up period after Descemet’s stripping automated endothelial keratoplasty (DSAEK).Methods and analysisThis retrospective study involved 130 eyes of 130 consecutive patients with Fuchs endothelial corneal dystrophy (FECD), non-FECD bullous keratopathy (BK) (non-FECD) or BK post-trabeculectomy or tube-shunt surgery (glaucoma with bleb) who underwent DSAEK between August 2007 and January 2012 and were followed for more than 5 years postoperatively. Patients with previous keratoplasty, graft suture failure, primary graft failure, postoperative endophthalmitis and ocular infection were excluded. Graft survival and ECD was then examined in all patients who underwent DSAEK and completed the postoperative follow-up period. The association between clinical factors and 5-year graft survival after DSAEK was analysed with multivariate logistic regression analysis.ResultsThe overall graft survival rate at 5 years postoperatively was 85%, yet significantly poorer in the glaucoma with bleb eyes (47%) than in the FECD (100%) or non-FECD (90%) eyes (p<0.01, log-rank test). In the FECD, non-FECD and glaucoma with bleb eyes, the mean ECD at 5 years postoperatively was 1054 cells/mm2, 1137 cells/mm2and 756 cells/mm2, respectively. Multivariate logistic regression analysis showed history of trabeculectomy or tube-shunt surgery and postoperative allograft rejection to be negative factors for graft survival at 5 years after DSAEK (OR 0.01, 95% CI 0.00 to 0.10 and OR 0.02, 95% CI 0.00 to 0.33, respectively).ConclusionOur findings show that at 5 years postoperatively, the surgical outcome after DSAEK was poorer in eyes after trabeculectomy or tube-shunt surgery.Trial registration numberUMIN000024891.