Primary graft failure after Descemet-stripping automated endothelial keratoplasty - Clinico-pathological study
Primary graft failure after Descemet-stripping automated endothelial keratoplasty - Clinico-pathological study
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DOI：
10.1097/qai.0b013e31815e92ac
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发表时间：
2008-07-01
期刊：
影响因子：
2.8
通讯作者：
Tan, Donald
中科院分区：
文献类型：
--
作者：
Mehta, Jodhbir Singh;Chua, Jocelyn;Tan, Donald
目的：后弹力层剥脱式自动内皮角膜移植术（DSAEK）是一种选择性组织角膜移植手术，其中仅更换病变的内皮和后弹力层。该手术的屈光和视力结果令人鼓舞，但原发性移植失败率较高。我们在此报告2例DSAEK术后原发性移植物衰竭的组织病理学和超微结构变化。方法：2例DSAEK术后原发性移植物衰竭病例。1例患者因Fuchs内皮营养不良接受DSAEK，另1例患者因人工晶状体大泡性角膜病变接受DSAEK。术后，没有移植物脱位，但1例患者发生鼻后弹力层脱离，前房内空气使其复位。术后一个月，视力没有改善，两名患者的受体和供体角膜都有明显的肿胀。2例患者均接受了移植物交换。结果：组织学检查显示角膜水肿明显，内皮细胞减少。超微结构评价显示，1份样本中仅存在残余内皮细胞膜，无任何细胞内内容物。透射电子显微镜显示，广泛受损的角膜细胞在深后方基质的存在下，也在接口在移植物-宿主junctions.Conclusions：这些情况下显示广泛的和不可恢复的内皮细胞和角膜细胞损伤的患者与原发性移植失败后DSAEK。
Purpose: Descemet-stripping automated endothelial keratoplasty (DSAEK) is a selective tissue corneal transplantation procedure in which only the diseased endothelium and the Descemet membrane is replaced. Refractive and visual results have been encouraging with this procedure, but higher rates of primary graft failure have been noted. We herein report histopathologic and ultrastructural changes in 2 cases of primary graft failure after DSAEK. We are not aware of these features being reported previouslyMethods: Two cases of primary graft failure after DSAEK. One patient underwent DSAEK for Fuchs endothelial dystrophy and the other for pseudophakic bullous keratopathy Both DSAEK procedures were uneventful. Postoperatively, there was no graft dislocation, but 1 patient had a nasal Descemet detachment that was reapposed with intracameral air. One month postoperatively, there was no improvement in the vision, and both patients had pronounced swelling of the recipient and donor corneas. Both patients underwent graft exchange. Both the recipient and donor corneal edema resolved.Results: Histopathologic evaluation showed marked corneal edema and loss of endothelial cells. Ultrastructural evaluation showed only remnant endothelial cell membranes present in 1 sample devoid of any intracellular contents. Transmission electron microscopy showed the presence of extensively damaged keratocytes in the deep posterior stroma and also in the interface at the graft-host junction.Conclusions: These cases show widespread and irrecoverable endothelial and keratocyte damage in patients with primary graft failure after DSAEK.