Clinical and Histopathologic Features of Failed Descemet Stripping Automated Endothelial Keratoplasty Grafts
Clinical and Histopathologic Features of Failed Descemet Stripping Automated Endothelial Keratoplasty Grafts
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DOI：
10.1097/ico.0b013e31818d3b1c
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发表时间：
2009-06-01
期刊：
影响因子：
2.8
通讯作者：
Edward, Deepak P.
中科院分区：
文献类型：
--
作者：
Lee, Janet A.;Djalilian, Ali R.;Edward, Deepak P.
目的：研究移植失败后后弹力层剥离自动内皮角膜移植术（DSAEK）移植物的组织病理学特征，并与相关临床特征相关。方法：对7例在外科医生学习阶段经历DSAEK移植失败的患者中的8例进行回顾性研究。围手术期临床结果与外植移植物标本的病理结果相关。使用成像软件测量每个移植物的中心和周边厚度。结果：移植物失败的发生与移植物脱离或过度的手术操作有关。 4例供体组织脱落，其中2例有气泡逸出通道。 3 例中，移植物仍附着但未能清除。术前 DSAEK 按钮的平均厚度为 205 +/- 61.8 μm。平均死亡至保存时间为8小时47分钟，平均保存至手术时间为2天22小时。通过光学显微镜观察，移植的供体组织显示出不同程度的角膜细胞变性和明显的内皮细胞损失。两个有气泡逸出的标本具有较少的内皮损失，并且I标本显示界面处有上皮向内生长。重复角膜移植术（5 例 DSAEK，2 例穿透性角膜移植术）在 7 例病例中的 6 例中获得成功。结论：该系列将可能导致 DSAEK 失败的因素与外植 DSAEK 微透镜的组织病理学特征相关联。明显的内皮损失在手术创伤的病例中很常见，但在气泡逸出的病例中较少。一份样本显示基质界面上有上皮膜。这些患者重复 DSAEK 的结果似乎很有希望。
Purpose: To study the histopathologic features of Descemet stripping automated endothelial keratoplasty (DSAEK) grafts removed after graft failure and to correlate with relevant clinical features.Methods: Retrospective study of 8 cases in 7 patients who experienced DSAEK graft failure during the surgeons' learning phase. Perioperative clinical findings were correlated with pathologic findings of the explanted graft specimens. Imaging software was used to measure the central and peripheral thickness of each graft.Results: Graft failure occurred in association with graft detachment or excessive surgical manipulation. In 4 cases, the donor tissue detached, including 2 cases with routes for bubble escape. In 3 cases, the graft remained attached but failed to clear. The mean preoperative DSAEK button thickness was 205 +/- 61.8 mu m. Average death to preservation time was 8 hours 47 minutes, and average preservation to surgery time was 2 days 22 hours. By light microscopy, explanted donor tissue showed varying degrees of keratocyte degeneration and marked endothelial cell loss. Two specimens with bubble escape had less endothelial loss, and I specimen showed epithelial ingrowth at the interface. Repeat keratoplasty (5 DSAEK, 2 penetrating keratoplasty) was successful in 6 of 7 cases.Conclusions: This series correlates factors that may play a role in DSAEK failure with histopathologic features of explanted DSAEK lenticules. Marked endothelial loss was common in cases with surgical trauma but was less in cases with bubble escape. One specimen showed an epithelial membrane on the stromal interface. Outcomes of repeat DSAEK in these patients seem promising.