Rose Linda, Briceño César A, Stark Walter J, Gloria Dante G, Jun Albert S
Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Ophthalmology. 2008 Feb;115(2):279-86. doi: 10.1016/j.ophtha.2007.04.020. Epub 2007 Jun 28.
To evaluate eye bank-prepared tissue for Descemet's stripping automated endothelial keratoplasty (DSAEK).
Experimental study and retrospective case series.
Seventeen human donor corneas and 4 recipient patients undergoing DSAEK surgery.
Corneal-scleral discs were obtained. Specular microscopy and pachymetry were performed. A designated Tissue Banks International technician used a microkeratome to prepare a flap. Posterior bed thickness was measured. The sectioned tissue was stored, and at 24 and 48 hours, pachymetry was repeated. At 48 hours, specular microscopy was repeated, and endothelial cell viability was assessed with trypan blue. Descemet's stripping automated endothelial keratoplasty was performed in 4 patients using eye bank-prepared posterior lamellar tissue.
Corneal tissue was assessed with the following parameters: corneal thickness measured with ultrasonic pachymetry, cell density counts measured with a keratoanalyzer, and cell viability as observed with trypan blue exclusion. Patient outcomes were measured by changes in visual acuity (VA) and the presence of a clear graft.
Donor corneal pachymetry before sectioning averaged 599+/-52 microm. Immediately after sectioning with a microkeratome set at a depth of 300 microm, mean posterior bed thickness was 328+/-95 microm. Thus, the mean cutting depth achieved by the microkeratome when set at 300 micrometers averaged 271+/-83 microm. After storage for 24 hours, the posterior beds measured 352 microm, an average swelling of 24 (7%) microm (P = 0.14). After 48 hours, the posterior beds measured 382 microm, an average swelling of 54 (16%) microm (P = 0.02). Cell counts 48 hours after sectioning decreased by an average of 11% (P = 0.10). Endothelial cell staining confirmed improvement in postsectioning morphology and survival with increased technician experience. All 4 patients receiving eye bank-prepared DSAEK tissue showed uncomplicated postoperative results, with improvement in VA.
The microkeratome cutting depth was moderately accurate. Pachymetry, cell density, and cell viability of sectioned tissue after 48 hours in storage were encouraging overall. Initial clinical results of eye bank-prepared DSAEK tissue showed uncomplicated postoperative courses and improved VA. Additional studies are needed to follow the long-term outcomes in the recipients of these tissues.
评估眼库制备的组织用于后弹力层剥除自动角膜内皮移植术（DSAEK）的效果。
实验研究和回顾性病例系列。
17个人类供体角膜和4例接受DSAEK手术的受者。
获取角膜-巩膜片。进行镜面显微镜检查和测厚。指定的国际组织库技术人员使用微型角膜刀制作瓣片。测量后弹力层床厚度。将切片组织储存起来，在24小时和48小时时重复进行测厚。在48小时时，重复进行镜面显微镜检查，并用台盼蓝评估内皮细胞活力。4例患者使用眼库制备的后弹力层组织进行了后弹力层剥除自动角膜内皮移植术。
用以下参数评估角膜组织：用超声测厚仪测量角膜厚度，用角膜分析仪计数细胞密度，用台盼蓝排斥法观察细胞活力。通过视力（VA）变化和植片透明情况来衡量患者的预后。
切片前供体角膜平均厚度为599±52微米。用设定深度为300微米的微型角膜刀切片后，后弹力层床平均厚度为328±95微米。因此，微型角膜刀设定在300微米时的平均切割深度为271±83微米。储存24小时后，后弹力层床厚度为352微米，平均肿胀24（7%）微米（P = 0.14）。48小时后，后弹力层床厚度为382微米，平均肿胀54（16%）微米（P = 0.02）。切片后48小时细胞计数平均下降11%（P = 0.10）。内皮细胞染色显示随着技术人员经验增加，切片后形态和存活率有所改善。所有4例接受眼库制备的DSAEK组织的患者术后结果均无并发症，视力有所提高。
微型角膜刀的切割深度中等准确。储存48小时后的切片组织的测厚、细胞密度和细胞活力总体上令人鼓舞。眼库制备的DSAEK组织的初步临床结果显示术后过程无并发症且视力提高。需要进一步研究来跟踪这些组织受者的长期预后。
