Covert Douglas J, Koenig Steven B
Eye Institute, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin, USA.
Ophthalmology. 2007 Jul;114(7):1272-7. doi: 10.1016/j.ophtha.2006.12.030. Epub 2007 Apr 12.
To evaluate visual acuity (VA), graft clarity, and refractive outcome of Descemet's stripping and automated endothelial keratoplasty (DSAEK) combined with phacoemulsification and intraocular lens (IOL) implantation in patients with coexisting Fuchs' endothelial dystrophy and immature senile cataracts.
Pilot, prospective, noncomparative, surgical case series.
Twenty-one eyes of 21 consecutive patients with coexisting visually significant immature senile cataracts and Fuchs' corneal dystrophy with guttata of Descemet's membrane and either microcystic epithelial edema or stromal edema presenting to a single academic eye institute.
All patients underwent phacoemulsification and posterior chamber IOL implantation through temporal clear corneal incision, followed by DSAEK. The intent was to render all eyes as close to emmetropia as possible.
Six-month postoperative best spectacle-corrected VA (BSCVA), refractive spherical equivalent (SE), refractive astigmatism, and keratometry.
Average BSCVAs were 20/68 preoperatively and 20/34 postoperatively (P<0.0001). The postoperative SE refractive error was +0.45 diopters (D), on average +1.13 D more hyperopic than predicted by preoperative lens power calculations. Overall, 13 patients (62%) were within 1.00 D and 21 (100%) were within 2.00 D of emmetropia postoperatively. Preoperative and postoperative average refractive astigmatisms were 1.46 D and 1.56 D, respectively (P = 0.69). Complications included graft dislocations requiring repositioning (3), 2 of which experienced recurrent dislocation requiring reoperation with a new graft; acute graft rejection (3); and pupillary block glaucoma (2).
This pilot case series of 6-month results of DSAEK combined with phacoemulsification and IOL implantation suggests that it provides rapid visual rehabilitation with predictable refractive outcomes.
评估在患有富克斯内皮营养不良和未成熟老年性白内障的患者中，Descemet膜剥除及自动内皮角膜移植术（DSAEK）联合超声乳化白内障吸除术和人工晶状体（IOL）植入术的视力（VA）、移植片清晰度和屈光结果。
前瞻性、非对照性手术病例系列试点研究。
连续21例患有视力显著的未成熟老年性白内障和富克斯角膜营养不良且Descemet膜有滴状病变以及伴有微囊性上皮水肿或基质水肿的患者的21只眼，均就诊于一家学术性眼科机构。
所有患者均通过颞侧透明角膜切口进行超声乳化白内障吸除术和后房型人工晶状体植入术，随后进行DSAEK。目的是使所有眼睛尽可能接近正视。
术后6个月最佳矫正视力（BSCVA）、屈光球镜等效度（SE）、屈光性散光和角膜曲率计测量值。
术前平均BSCVA为20/68，术后为20/34（P<0.0001）。术后SE屈光不正平均为+0.45屈光度（D），比术前晶状体屈光度计算预测的远视程度平均多1.13 D。总体而言，13例患者（62%）术后在正视眼的1.00 D范围内，21例患者（100%）在2.00 D范围内。术前和术后平均屈光性散光分别为1.46 D和1.56 D（P = 0.69）。并发症包括需要重新定位的移植片脱位（3例），其中2例出现复发性脱位，需要用新的移植片再次手术；急性移植片排斥反应（3例）；以及瞳孔阻滞性青光眼（2例）。
这个关于DSAEK联合超声乳化白内障吸除术和人工晶状体植入术6个月结果的试点病例系列表明，该手术能实现快速的视力恢复，且屈光结果可预测。
