Femtosecond laser-assisted Descemet's stripping endothelial keratoplasty: a prospective study of 6-month visual outcomes, corneal thickness and endothelial cell loss
Femtosecond laser-assisted Descemet's stripping endothelial keratoplasty: a prospective study of 6-month visual outcomes, corneal thickness and endothelial cell loss
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飞秒激光辅助后弹力层剥离内皮角膜移植术：一项关于 6 个月视力结果、角膜厚度和内皮细胞损失的前瞻性研究
DOI：
10.1007/s10792-020-01383-8
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发表时间：
2020-04-21
影响因子：
1.6
通讯作者：
Xu，Jianjiang
中科院分区：
文献类型：
--
作者：
Chen，Huiyu;Tian，Lijia;Xu，Jianjiang
PurposeTo报告接受飞秒激光辅助后弹力层剥脱内皮角膜移植术（FS-DSEK）患者的视力、角膜厚度和内皮细胞密度（ECD）的6个月结局。MethodsThis前瞻性、连续、干预性系列检查了25例患者的25只眼，这些患者接受FS-DSEK治疗Fuchs内皮营养不良和大泡性角膜病变。切割前角膜内皮移植物厚度（CET）为150 µm。术后1周、1、2、3、6个月分别测定最佳矫正视力（BCVA）、中央角膜厚度（CCT）、供体角膜厚度（CET）、受体角膜基质厚度（CST）和ECD.Results6个月时的平均BCVA为0.76 ± 0.35 logMAR单位，较术前1.54 ± 0.52 logMAR单位提高。CCT显著降低，从术后1周的759.8 ± 152.4 µm降至术后6个月的631.7 ± 79.7 µm（P= 0.001）。6个月时CET恢复至切割前状态的153.4 ± 33.7 µm（P= 0.076）。CST从1周时的561.5 ± 96.3 µm降至6个月时的479.7 ± 57.9 µm（P< 0.001）。术前供体ECD为2747.6 ± 255.4 cells/mm 2，6个月时降至1729.1 ± 562.9 cells/mm 2，峰值ECD损失为36.86%。术后1周至6个月观察到的CST大幅下降与ECD丢失较低（P= 0.019）和术前ECD较低（P= 0.012）相关。然而，较薄的CET与较高的术前ECD相关（P= 0.028）。结论FS-DSEK是一种安全有效的角膜内皮失代偿的手术选择。供体ECD及其变化可作为CST和CET改善的预测因素。
PurposeTo report 6-month outcomes of visual acuity, the corneal thickness and endothelial cell density (ECD) in patients undergoing femtosecond laser-assisted Descemet’s stripping endothelial keratoplasty (FS-DSEK).MethodsThis prospective, consecutive, interventional series examined 25 eyes of 25 patients who underwent FS-DSEK for Fuchs endothelial dystrophy and bullous keratopathy. The pre-cut corneal endothelial graft thickness (CET) was 150 µm. Best-corrected visual acuity (BCVA), central corneal thickness (CCT), donor CET, recipient corneal stromal thickness (CST) and ECD were assessed at 1 week and 1, 2, 3 and 6 months postoperatively.ResultsThe mean BCVA at 6 months was 0.76 ± 0.35 logMAR units, improving from 1.54 ± 0.52 logMAR. CCT decreased significantly, from 759.8 ± 152.4 µm at 1 week to 631.7 ± 79.7 µm at 6 months (P= 0.001) postoperatively. CET recovered to 153.4 ± 33.7 µm (P= 0.076) at 6 months as pre-cut status. The CST decreased from 561.5 ± 96.3 µm at 1 week to 479.7 ± 57.9 µm at 6 months (P< 0.001). Preoperatively, the donor ECD was 2747.6 ± 255.4 cells/mm2, and the ECD decreased to 1729.1 ± 562.9 cells/mm2at 6 months, for a peak ECD loss of 36.86%. A greater decrease in CST observed from 1 week to 6 months postoperatively correlated with a lower ECD loss (P= 0.019) and a lower preoperative ECD (P= 0.012). However, a thinner CET correlated with a higher preoperative ECD (P= 0.028).ConclusionsFS-DSEK is a safe and effective surgical alternative for corneal endothelial decompensation. The donor ECD and its changes could be used as predictive factors for the improvement of CST and CET.