Devers Eye Institute, Portland, OR, USA.
Cornea. 2010 May;29(5):534-40. doi: 10.1097/ICO.0b013e3181c11bf3.
To evaluate the intraoperative and early postoperative outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with previous glaucoma filtering surgeries.
A retrospective review of all DSAEK surgeries performed at one center comparing complications of DSAEK in eyes with previous glaucoma filtering procedures (study eyes) with a time-matched group of all other DSAEK cases (control eyes).
There were 28 study eyes, 19 with previous trabeculectomies and 9 with previous glaucoma drainage devices (GDDs) and 431 control eyes. Study group intraoperative complications included 1 compromised bleb and 1 loss of donor tissue because of traumatic manipulation. One intraoperative complication, a perforation of the donor tissue, occurred in the control group. Venting stab incisions were used more often in study eyes (n = 5; 18%) than in control eyes (n = 12; 4.4%) (P = 0.002). GDD tubes were trimmed in 2 eyes (22%). No intraoperative manipulations were used to occlude the glaucoma filters or tubes. Postoperative complications in the study group included 1 dislocation (3.6%) and 1 decentered graft (3.6%) and 1 eye with loss of pressure control (3.6%), whereas in the control group, there were 10 dislocations (2.3%) and 1 decentered graft (0.2%) (P = 0.267 for dislocations and P = 0.118 for decentered grafts). One episode of pupillary block (0.2%) occurred in the control group, and none occurred in the study group. No primary graft failures occurred in either group.
DSAEK surgeries in eyes with previous glaucoma filtering procedures were performed without primary graft failure and with reasonably low dislocation (3.6%) and graft decentration (3.6%) rates. Although the intraoperative complication rate for the study group (7.1%) was higher than the rate for the control group (0.23%), excellent early postoperative outcomes can be achieved when DSAEK is performed in eyes with previous trabeculectomies and GDDs.
评估在有先前青光眼滤过手术史的患者中进行的撕囊自动化内皮角膜移植术（DSAEK）的术中及术后早期结果。
对在一个中心进行的所有 DSAEK 手术进行回顾性研究，比较了有先前青光眼滤过手术史的眼（研究眼）与所有其他 DSAEK 病例（对照组）的 DSAEK 并发症。
共有 28 只研究眼，19 只曾行小梁切除术，9 只曾行青光眼引流装置（GDD）手术，431 只对照组眼。研究组术中并发症包括 1 例滤过泡功能不良和 1 例供体组织因创伤性操作而丢失。对照组发生 1 例供体组织穿孔的术中并发症。在研究眼中，更常使用通气刺切（venting stab incision）切口（n = 5；18%），而在对照组中，仅使用 12 例（4.4%）（P = 0.002）。在 2 只眼中修剪了 GDD 管（22%）。术中未使用任何操作来闭塞青光眼滤过泡或管。研究组术后并发症包括 1 例脱位（3.6%）和 1 例移植片偏心（3.6%）以及 1 只眼眼压控制丧失（3.6%），而对照组中，有 10 例脱位（2.3%）和 1 例移植片偏心（0.2%）（脱位的 P = 0.267，偏心的 P = 0.118）。对照组中有 1 例发生瞳孔阻滞（0.2%），而研究组中无此情况发生。两组均未发生原发性移植物失功。
在有先前青光眼滤过手术史的眼中进行的 DSAEK 手术未发生原发性移植物失功，且脱位（3.6%）和移植片偏心（3.6%）发生率较低。尽管研究组（7.1%）的术中并发症发生率高于对照组（0.23%），但在有先前小梁切除术和 GDD 的眼中行 DSAEK 仍可获得良好的早期术后结果。
