Non-Descemet stripping automated endothelial keratoplasty for endothelial dysfunction secondary to argon laser iridotomy
Non-Descemet stripping automated endothelial keratoplasty for endothelial dysfunction secondary to argon laser iridotomy
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DOI：
10.1016/j.ajo.2008.05.028
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发表时间：
2008-10-01
影响因子：
4.2
通讯作者：
Sugiyama, Kazuhisa
中科院分区：
文献类型：
--
作者：
Kobayashi, Akira;Yokogawa, Hideaki;Sugiyama, Kazuhisa
目的：报告非des -水泥剥离自动内皮角膜移植术（nDSAEK）治疗氩激光虹膜切开术（ALI）继发内皮功能障碍的临床结果。设计：单中心、前瞻性、非比较性、干预性病例系列。方法：对6例ALI继发大疱性角膜病变患者（2男4女，平均年龄74.5岁）的6只眼进行内皮角膜移植术治疗，不进行受体Descemet剥离。供体内皮层通过使用Busin滑动和人工晶状体滑动（即Kobayashi双滑动技术）的拉穿技术插入。术前和术后6个月分别记录最佳矫正视力（BCVA）、散光和供体中央内皮细胞密度（ECD）。同时记录术中及术后并发症。主要观察指标为术前和术后中心ECD，并计算细胞损失率。评估BCVA、诱发性散光及并发症。结果：所有患者BCVA均大于20/32，其中2例（33.3%）达到20/20。可测病例的平均诱导散光为0.85±0.49屈光度。6个月时的ECD平均值和标准差为2390.5 +/- 522.4个细胞/mm(2)（范围1589 - 2898个细胞/mm(2)），表示术前供体细胞测量的平均细胞损失为25.8% +/- 14.7%。并发症包括1例供体脱位需要再泡（16.7%）和1例亚临床内皮排斥（16.7%）。结论：这种改良的内皮角膜移植术（nDSAEK和双滑动技术）治疗ALI继发性内皮功能障碍具有良好的临床效果，如减少内皮细胞损失，良好的视力和最小的诱导散光。
PURPOSE: To report clinical outcomes of non-Des-cemet stripping automated endothelial keratoplasty (nDSAEK) as treatment of endothelial dysfunction secondary to argon laser iridotomy (ALI).DESIGN: Single-center, prospective, noncomparative, interventional case series.METHODS: Six eyes of six patients (two men, four women; mean age, 74.5 years) with bullous keratopathies secondary to ALI were treated with endothelial keratoplasty without recipient Descemet stripping. The donor endothelial lamella was inserted using a pull-through technique using a Busin glide with intraocular lens glide (i.e., Kobayashi double-glide technique). Best-corrected visual acuity (BCVA), astigmatism, and donor central endothelial cell density (ECD) were recorded before surgery and at six months after surgery. Intraoperative and postoperative complications also were recorded. Main outcome measures were preoperative and postoperative central ECD, with calculation of cell loss rate. BCVA, induced astigmatism, and complications also were evaluated.RESULTS: All patients reached more than 20/32 BCVA, with two (33.3%) reaching 20/20. Mean induced astigmatism in measurable cases was 0.85 +/- 0.49 diopters. The average and standard deviation ECD at six months were 2390.5 +/- 522.4 cells/mm(2) (range, 1589 to 2898 cells/mm(2)), representing a mean cell loss from preoperative donor cell measurements of 25.8% +/- 14.7%. Complications included one case of donor dislocation requiring rebubbling (16.7%) and one case of subclinical endothelial rejection (16.7%).CONCLUSIONS: This modified endothelial keratoplasty technique (nDSAEK and double-glide technique) for treatment of endothelial dysfunction secondary to ALI produced excellent clinical outcomes such as reduced endothelial cell loss, good visual acuity, and minimal induced astigmatism.