Prasher Pawan, Muftuoglu Orkun, Bowman R W, McCulley James P, Petroll W Matthew, Cavanagh H Dwight, Mootha V Vinod
Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, 75390-9057, USA.
Eye Contact Lens. 2009 Jul;35(4):196-202. doi: 10.1097/ICL.0b013e3181abb596.
To evaluate the changes in the corneal stroma after Descemet stripping automated endothelial keratoplasty (DSAEK) using tandem scanning confocal microscopy (CM).
Thirteen eyes of 13 patients who underwent DSAEK without preoperative corneal haze or scar obvious at the slit lamp, any ocular disease, and postoperative complication were included in the study. All patients were examined clinically and by CM 6 months after DSAEK.
Six months after DSAEK, none of the eyes had clinically significant interface haze (i.e., haze affecting quantity or quality of vision) at slit lamp. The mean best spectacle corrected visual acuity was 0.18 +/- 0.12 (range 0-0.4) logMAR (Snellen 20/30). The CM revealed highly reflective particles in interface in six eyes, particles with mild surrounding increased reflectivity in four eyes, and no discernible interface in three eyes. The mean particles density at interface was 28.6 +/- 23.4 particles/mm. No significant keratocyte activation was seen in any case at the interface. The mean anterior stromal reflectivity was 431.2 +/- 269.1 confocal back scatter units (CBU) and the mean interface reflectivity was 65.9 +/- 46.9 CBU. The mean anterior stromal reflectivity was significantly greater than the mean interface reflectivity (P<0.01). Significant keratocyte activation with high reflectivity was seen in superficial anterior stroma in 8 of 13 eyes.
Tandem scanning CM shows the presence of highly reflective particles at the level of the DSAEK interface that are morphologically similar to a laser in situ keratomileusis interface. The stromal reflectivity is more prominent in subepithelial layers than that of interface 6 months after DSAEK. However, the areas under the mean reflectivity peaks (CBU) corresponding to the flap interface and superficial anterior stroma do not seem to correlate with best spectacle corrected visual acuity results after the procedure.
使用串联扫描共焦显微镜（CM）评估后弹力层剥除自动内皮角膜移植术（DSAEK）后角膜基质的变化。
本研究纳入13例患者的13只眼，这些患者接受了DSAEK，术前在裂隙灯下无明显角膜混浊或瘢痕，无任何眼部疾病，且术后无并发症。所有患者在DSAEK术后6个月进行临床检查和CM检查。
DSAEK术后6个月，所有眼在裂隙灯下均无临床显著的界面混浊（即混浊影响视力的数量或质量）。最佳矫正视力的平均值为0.18±0.12（范围0 - 0.4）logMAR（Snellen 20/30）。CM显示6只眼的界面中有高反射颗粒，4只眼的颗粒周围有轻度反射率增加，3只眼无明显界面。界面处的平均颗粒密度为28.6±23.4个颗粒/mm。在任何情况下，界面处均未观察到明显的角膜细胞活化。前基质的平均反射率为431.2±269.1共焦后向散射单位（CBU），界面的平均反射率为65.9±46.9 CBU。前基质的平均反射率显著高于界面的平均反射率（P<0.01）。13只眼中有8只眼的浅层前基质中可见有高反射率的明显角膜细胞活化。
串联扫描CM显示DSAEK界面处存在形态上类似于准分子激光原位角膜磨镶术界面的高反射颗粒。DSAEK术后6个月，基质反射率在上皮层下比界面更明显。然而，与瓣界面和浅层前基质相对应的平均反射率峰值（CBU）下的面积似乎与术后最佳矫正视力结果无关。
