Chih Andreea, Lugo Miguel, Kowing Dianne
William Chappell, Jr. VA Medical Center, Daytona Beach, Florida 32114, USA.
Optom Vis Sci. 2008 Mar;85(3):152-7. doi: 10.1097/OPX.0b013e3181646d2f.
To discuss Descemet stripping and automated endothelial keratoplasty (DSAEK) as an alternative to penetrating keratoplasty (PK), and to review the evolution of endothelial keratoplasty (EK) for endothelial dysfunction.
The endothelium of the right eye was removed through a 5-mm limbal incision and was replaced with a prepared donor endothelium that included posterior stromal tissue.
After DSAEK, the patient's vision improved more rapidly and remained more stable than is typical for patients undergoing PK.
DSAEK provides an alternative both to PK and to a repeat PK in patients with failed grafts because of endothelial cell dysfunction. The advantages DSAEK surgery can offer are a quicker visual recovery, a more stable refraction, a tectonically more stable globe, and fewer ocular surface defects associated with corneal sutures or the surface graft host interface. The limitations associated with DSAEK include donor button dislocation and endothelial cell loss and dysfunction. Whether DSAEK or PK offers the best visual outcome and graft survival over the long term is unknown. Caution is advised until multicenter trials confirm the optimal procedure.
探讨后弹力层剥除自动内皮角膜移植术（DSAEK）作为穿透性角膜移植术（PK）的替代方法，并回顾内皮角膜移植术（EK）治疗内皮功能障碍的发展历程。
通过5毫米角膜缘切口切除右眼内皮，并用包含后基质组织的制备好的供体内皮进行替换。
DSAEK术后，患者视力改善比接受PK的患者更快且更稳定。
对于因内皮细胞功能障碍导致移植失败的患者，DSAEK为PK及再次PK提供了一种替代方法。DSAEK手术的优点包括视力恢复更快、屈光更稳定、眼球结构更稳定以及与角膜缝线或表面移植宿主界面相关的眼表缺陷更少。与DSAEK相关的局限性包括供体植片脱位以及内皮细胞丢失和功能障碍。从长期来看，DSAEK还是PK能提供最佳视力结果和移植存活率尚不清楚。在多中心试验确认最佳手术方法之前，建议谨慎行事。
