Kitzmann Anna S, Goins Kenneth M, Reed Cynthia, Padnick-Silver Lissa, Macsai Marian S, Sutphin John E
Department of Ophthalmology, University of Iowa, Iowa City, IA 52242, USA.
Cornea. 2008 Jul;27(6):634-9. doi: 10.1097/QAI.0b013e31815e4011.
To assess surgeon satisfaction with precut corneal tissue from 1 eye bank for Descemet stripping automated endothelial keratoplasty (DSAEK). Surgical techniques and predictors of procedural success were also examined.
A 19-question survey was completed by 53 surgeons around the United States for 197 DSAEK cases using prepared corneal allograft tissue from the Iowa Lions Eye Bank. Surgeries were performed between April 1 and December 31, 2006; surveys were completed retrospectively within a few weeks of surgery.
Tissue was found to be acceptable in 98% of DSAEK cases reported. Difficulties with precut tissue (eg, lack of anterior cap adherence to the posterior lamella, not visible or decentered central dot, anterior edge undermining) were reported in approximately 10% of cases. A rebubbling procedure was performed in 23% of cases for donor dislocations. The donor lenticule adhered, with resulting corneal deturgescence, in 86% of cases. Surgeons declared a successful procedure in 92% of cases. Of the 14 unsuccessful cases, donor tissue quality was the underlying etiology in only 1 case. Procedural success rates were related to surgeon experience (P = 0.002), lenticule adherence after only 1 anterior chamber air bubble (P = 0.005), no small perforations to release fluid (P = 0.005), and the presence of corneal deturgescence (P = 0.002).
The use of precut tissue for DSAEK is not associated with increased risk of complications related to tissue preparation. With standardization of precutting donor tissue, safety of DSAEK surgery may be improved while increasing surgeon efficiency.
评估外科医生对来自一家眼库的预切割角膜组织用于Descemet膜剥离自动内皮角膜移植术（DSAEK）的满意度。同时也研究了手术技术及手术成功的预测因素。
美国各地的53位外科医生针对197例使用爱荷华狮子眼库制备的角膜同种异体移植组织进行的DSAEK病例完成了一项包含19个问题的调查。手术于2006年4月1日至12月31日期间进行；调查在术后几周内进行回顾性完成。
在报告的98%的DSAEK病例中，组织被认为是可接受的。约10%的病例报告了预切割组织存在困难（例如，前帽与后板层不粘连、中央点不可见或偏心、前缘破坏）。23%的病例因供体脱位进行了再气泡形成操作。86%的病例中供体晶状体瓣粘连，角膜随之消肿。92%的病例中外科医生宣布手术成功。在14例未成功的病例中，供体组织质量仅在1例中是根本病因。手术成功率与外科医生经验（P = 0.002）、仅在前房有一个气泡后晶状体瓣粘连（P = 0.005）、无小穿孔以释放液体（P = 0.005）以及角膜消肿的存在（P = 0.002）有关。
DSAEK使用预切割组织与组织制备相关并发症风险增加无关。通过预切割供体组织的标准化，DSAEK手术的安全性可能会提高，同时提高外科医生的效率。
