Price Marianne O, Price Francis W
Cornea Research Foundation of America, Indianapolis, IN, USA.
Curr Opin Ophthalmol. 2007 Jul;18(4):290-4. doi: 10.1097/ICU.0b013e3281a4775b.
Descemet's stripping endothelial keratoplasty (DSEK) is rapidly becoming the preferred treatment for corneal endothelial dysfunction. Familiarity with recent advances in techniques and instrumentation can help reduce the initially steep learning curve and incidence of complications.
DSEK produces excellent visual outcomes with minimal change in corneal surface topography or refraction. It can successfully treat corneal dysfunction associated with Fuchs' endothelial dystrophy, bullous keratopathy, iridocorneal endothelial syndrome or a failed penetrating graft. Donor dissection has become automated, and new techniques have been devised to facilitate graft insertion and unfolding. Some surgeons now routinely perform DSEK with topical anesthesia. Graft detachment is the most frequent early postoperative complication, but new methods can help promote donor adherence. The incidence of graft-rejection episodes is lower after DSEK compared with standard penetrating keratoplasty, possibly because wound healing is a lesser concern, and many DSEK patients are maintained on low-dose topical steroids indefinitely. Early efforts to transplant just the endothelial cell layer show promise.
DSEK provides quicker visual rehabilitation and an improved safety profile compared with standard penetrating keratoplasty. Continued evolution of this relatively new technique is helping to reduce complications and further improve outcomes.
后弹力层剥除内皮角膜移植术（DSEK）正迅速成为角膜内皮功能障碍的首选治疗方法。熟悉技术和器械的最新进展有助于降低最初较陡的学习曲线和并发症发生率。
DSEK能产生极佳的视觉效果，角膜表面地形图或屈光度变化极小。它能成功治疗与Fuchs内皮营养不良、大疱性角膜病变、虹膜角膜内皮综合征或穿透性移植失败相关的角膜功能障碍。供体剥离已实现自动化，并且已设计出新的技术来促进移植物的植入和展开。现在一些外科医生常规采用表面麻醉进行DSEK手术。移植物脱离是术后早期最常见的并发症，但新方法有助于促进供体附着。与标准穿透性角膜移植术相比，DSEK术后移植物排斥反应的发生率较低，这可能是因为伤口愈合问题较小，而且许多DSEK患者长期使用低剂量表面类固醇药物。早期仅移植内皮细胞层的努力显示出前景。
与标准穿透性角膜移植术相比，DSEK能提供更快的视觉康复和更好的安全性。这项相对新技术的持续发展有助于减少并发症并进一步改善治疗效果。
