Vajaranant Thasarat S, Price Marianne O, Price Francis W, Gao Weihua, Wilensky Jacob T, Edward Deepak P
Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W. Taylor Street, Chicago, IL 60612, USA.
Ophthalmology. 2009 Sep;116(9):1644-50. doi: 10.1016/j.ophtha.2009.05.034. Epub 2009 Jul 29.
(1) To characterize the pattern of intraocular pressure (IOP) changes after Descemet's stripping endothelial keratoplasty (DSEK) in patients without preexisting glaucoma and in those with preexisting glaucoma, with and without prior glaucoma surgery. (2) To compare vision and IOP outcomes among the 3 groups.
A retrospective chart review.
A total of 805 DSEK cases performed in 641 patients by a single surgeon from December 2003 to August 2007 were available in the database. Only the first-treated eye of each patient with at least 1-year follow-up was included. Four hundred cases qualified: 315 eyes had no glaucoma (C); 64 eyes had glaucoma with no previous glaucoma surgery (G); and 21 eyes had prior glaucoma surgery (GS). Eyes with preexisting retinal problems were included in the analysis.
Data analysis included calculation of incidence of postoperative IOP elevation. The study criteria for postoperative IOP elevation were IOP > or =24 mmHg or IOP increase > or =10 mmHg from baseline. Kruskal-Wallis test was used to compare visual acuity (VA) and IOP among the 3 groups preoperatively and at 1-, 3-, 6-, and 12-month postoperative visits.
Visual acuity (Snellen) and IOP (millimeters of mercury).
The incidence of postoperative IOP elevation by the study criteria was 35%, 45%, and 43% for groups C, G, and GS, respectively. Elevated IOP was medically managed by initiating or increasing glaucoma medications or reducing steroids in 27%, 44%, and 38% of the patients in groups C, G, and GS, respectively. A subsequent glaucoma procedure was performed in 0.3%, 5%, and 19% of patients in groups C, G, and GS, respectively. Only the control group had statistically significant IOP elevation at 12 months (median increase of 2 mmHg) when compared with baseline (P<0.0001). All 3 groups had statistically significant improvement in vision at 12 months when compared with baseline (12-month median VA = 20/40 for C and G; and 20/50 for GS, P<0.0001).
All groups had a substantial incidence of IOP elevation after DSEK. Close monitoring of IOP is warranted. In this cohort, preexisting glaucoma did not seem to have a negative effect on VA after DSEK.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
（1）描述在无青光眼病史以及有青光眼病史（无论是否曾接受青光眼手术）的患者中，施行Descemet膜剥除内皮角膜移植术（DSEK）后眼压（IOP）的变化模式。（2）比较三组患者的视力和眼压结果。
一项回顾性图表审查。
数据库中存有2003年12月至2007年8月间由同一位外科医生为641例患者施行的805例DSEK病例。仅纳入每位患者至少随访1年的首治眼。400例符合条件：315眼无青光眼（C组）；64眼有青光眼但未曾接受青光眼手术（G组）；21眼曾接受青光眼手术（GS组）。分析中纳入了存在视网膜疾病史的眼。
数据分析包括计算术后眼压升高的发生率。术后眼压升高的研究标准为眼压≥24 mmHg或眼压较基线升高≥10 mmHg。采用Kruskal-Wallis检验比较三组患者术前以及术后1个月、3个月、6个月和12个月时的视力（VA）和眼压。
视力（Snellen视力表）和眼压（毫米汞柱）。
根据研究标准，C组、G组和GS组术后眼压升高的发生率分别为35%、45%和43%。C组、G组和GS组分别有27%、44%和38%的患者通过开始或增加青光眼药物治疗或减少类固醇药物来控制眼压升高。C组、G组和GS组分别有0.3%、5%和19%的患者随后接受了青光眼手术。与基线相比，仅对照组在12个月时眼压有统计学意义的升高（中位数升高2 mmHg）（P<0.0001）。与基线相比，所有三组在12个月时视力均有统计学意义的改善（C组和G组12个月时的中位数视力为20/40；GS组为20/50，P<0.0001）。
所有组在DSEK术后眼压升高的发生率都很高。有必要密切监测眼压。在该队列中，既往存在的青光眼似乎对DSEK术后的视力没有负面影响。
在参考文献之后可能会有专利或商业披露信息。
