Ponchel C, Arné J-L, Malecaze F, Fournié P
Service d'Ophtalmologie, CHU Toulouse, Hôpital Purpan, Toulouse, France.
J Fr Ophtalmol. 2009 Apr;32(4):257-62. doi: 10.1016/j.jfo.2009.02.002. Epub 2009 Mar 27.
Descemet stripping automated endothelial keratoplasty (DSAEK) is an exciting alternative to standard full-thickness penetrating keratoplasty (PK) for the treatment of patients suffering from endothelial failure of the cornea. Corneal transplant rejection is the leading cause of endothelial failure after PK. While DSAEK may reduce the risk of corneal allograft rejection, endothelial rejection can still occur.
We report three cases of endothelial rejection after DSAEK. Subacute endothelial rejection occurred in all three cases after the topical steroid treatment regimen had been stopped.
A lower rejection rate in comparison with PK cannot be assumed and comparative studies are necessary. Extended topical steroid may be used. Subacute endothelial graft rejection implies that the patient needs to be fully informed of the functional signs and the need to seek medical advice immediately.
对于患有角膜内皮功能衰竭的患者，Descemet膜剥脱自动内皮角膜移植术（DSAEK）是标准全层穿透性角膜移植术（PK）的一种令人兴奋的替代方法。角膜移植排斥是PK术后内皮功能衰竭的主要原因。虽然DSAEK可能会降低角膜同种异体移植排斥的风险，但内皮排斥仍可能发生。
我们报告了3例DSAEK术后发生内皮排斥的病例。在停用局部类固醇治疗方案后，所有3例均发生了亚急性内皮排斥。
不能假定DSAEK的排斥率低于PK，需要进行对比研究。可使用延长的局部类固醇治疗。亚急性内皮移植排斥意味着需要让患者充分了解功能体征以及立即寻求医疗建议的必要性。
