Phillips Paul M, Terry Mark A, Shamie Neda, Chen Edwin S, Hoar Karen L, Stoeger Chris, Friend Daniel J, Saad Hisham A
Devers Eye Institute, Portland, OR 97210, USA.
Cornea. 2009 Sep;28(8):871-6. doi: 10.1097/ICO.0b013e318199f8d7.
The purpose of this study was to evaluate outcomes of Descemet's stripping automated endothelial keratoplasty (DSAEK) using anterior stromal flawed (ASF) donor corneas that were unsuitable for use in full-thickness penetrating keratoplasty as a result of stromal scars, pterygia, or previous corneal refractive surgery and to compare results with DSAEK using standard tissue.
We conducted a review of our initial 42 (19 with 6-month follow up) consecutive DSAEK surgeries using ASF tissue compared with 357 (199 with 6-month follow up) time-matched controls using standard tissue. Intraoperative and perioperative complications, including dislocations and primary graft failures, were compared. Six-month best spectacle-corrected vision, incidence of rejection episodes, postoperative refractive astigmatism, keratometric values, pre- and postoperative topography-derived surface asymmetry index, and surface regularity index were compared.
One surgeon-cut ASF tissue was perforated before surgery and was discarded. No surgeon-cut standard tissue was perforated. No intraoperative complications and no episodes of primary graft failure or pupillary block glaucoma occurred in either group. One (2.4%) postoperative graft dislocation and one (5.2%) graft rejection episode occurred in the study group. There were 10 (2.8%) dislocations and 8 (2.2%) graft rejection in the controls. A statistically similar significant improvement in best spectacle-corrected vision occurred in both groups. Corneal topography, pachymetry, and manifest astigmatism were not significantly different between groups.
Postoperative results of DSAEK using donor tissue excluded from use in penetrating keratoplasty as a result of stromal flaws are equivalent to results using standard donor tissue. Central corneal thickness measurements should be performed before cutting to avoid tissue perforation. The use of ASF tissue for DSAEK will expand the cornea donor pool.
本研究旨在评估使用因基质瘢痕、翼状胬肉或既往角膜屈光手术而不适用于全层穿透性角膜移植术的前基质缺陷（ASF）供体角膜进行Descemet膜剥脱自动内皮角膜移植术（DSAEK）的效果，并将结果与使用标准组织的DSAEK进行比较。
我们回顾了最初42例（19例进行了6个月随访）使用ASF组织的连续DSAEK手术，并与357例（199例进行了6个月随访）使用标准组织的时间匹配对照进行比较。比较术中及围手术期并发症，包括脱位和原发性移植失败。比较6个月最佳眼镜矫正视力、排斥反应发生率、术后屈光性散光、角膜曲率值、术前和术后地形图衍生的表面不对称指数以及表面规则性指数。
一块术者切割的ASF组织在手术前穿孔并被丢弃。没有术者切割的标准组织穿孔。两组均未发生术中并发症、原发性移植失败或瞳孔阻滞性青光眼事件。研究组发生1例（2.4%）术后移植脱位和1例（5.2%）移植排斥反应。对照组有10例（2.8%）脱位和8例（2.2%）移植排斥反应。两组在最佳眼镜矫正视力方面均有统计学上相似的显著改善。两组之间角膜地形图、角膜厚度测量和明显散光无显著差异。
使用因基质缺陷而被排除用于穿透性角膜移植术的供体组织进行DSAEK的术后结果与使用标准供体组织的结果相当。切割前应进行中央角膜厚度测量以避免组织穿孔。将ASF组织用于DSAEK将扩大角膜供体库。
