Wake Forest University Eye Center, Winston-Salem, NC, USA.
Cornea. 2011 Feb;30(2):150-3. doi: 10.1097/ICO.0b013e3181e3f07e.
To report a Descemet stripping automated endothelial keratoplasty (DSAEK) insertion technique using sodium hyaluronate (Healon) and describe complication rates, visual acuity, and endothelial cell counts.
A retrospective analysis of 105 eyes in 91 patients undergoing DSAEK. Ninety-three eyes had Fuchs endothelial dystrophy, 11 had bullous keratopathy, and 1 had iridocorneal endothelial (ICE) syndrome. We noted pre- and postoperative visual acuity at 3 and 6 months, endothelial cell counts, and complications, including graft detachment rates. Thirty-six of 141 eyes met exclusion criteria of prior incisional corneal, glaucoma, or retinal surgery.
Because of graft detachment, 29 of 105 eyes (28%) required a re-bubble procedure at day 1 or week 1. Five of 105 grafts (4.8%) failed. Of note, in the last 35 cases, there were no graft failures and 5 detachments (14%). Twenty-eight percent of patients were 20/40 or better preoperatively compared with 49% at 3 months and 52% at 6 months. Excluding eyes with other ocular comorbidities (34), 62% were 20/40 or better at 3 months and 72% were 20/40 or better at 6 months. Postoperative endothelial cell counts were available for 52 eyes with an average cell loss of 44% at an average of 9.4 months.
DSAEK is an effective treatment for endothelial dysfunction, but the learning curve is steep. Anterior chamber stability, graft positioning, and small incision insertion are advantages to our technique. Disadvantages include a relatively high endothelial loss and dislocation rate. Minimizing endothelial cell loss and graft dislocation continue to be important goals for successful DSAEK.
报告一种使用透明质酸钠（Healon）的 Descemet 膜撕除式内皮角膜移植术（DSAEK）插入技术，并描述并发症发生率、视力和内皮细胞计数。
对 91 例 105 只眼行 DSAEK 的回顾性分析。93 只眼为 Fuchs 内皮营养不良，11 只眼为大泡性角膜病变，1 只眼为虹膜角膜内皮（ICE）综合征。我们记录了术前和术后 3 个月及 6 个月的视力、内皮细胞计数以及包括移植物脱离率在内的并发症。由于之前行过切口性角膜、青光眼或视网膜手术，141 只眼中有 36 只眼不符合纳入标准。
由于移植物脱离，105 只眼中有 29 只（28%）在第 1 天或第 1 周需要再次进行气泡处理。105 个移植物中有 5 个（4.8%）失败。值得注意的是，在最后 35 例中，没有移植物失败，只有 5 例（14%）脱离。28%的患者术前视力为 20/40 或更好，术后 3 个月时为 49%，6 个月时为 52%。排除有其他眼部合并症的患者（34 只眼），术后 3 个月时 62%的患者视力为 20/40 或更好，6 个月时为 72%。术后内皮细胞计数可用于 52 只眼，平均细胞丢失率为 44%，平均时间为 9.4 个月。
DSAEK 是治疗角膜内皮功能障碍的有效方法，但学习曲线陡峭。前房稳定性、移植物定位和小切口插入是我们技术的优势。缺点包括相对较高的内皮细胞丢失和脱位率。减少内皮细胞丢失和移植物脱位仍然是成功进行 DSAEK 的重要目标。
