Cornea Research Foundation of America, Indianapolis, Indiana 46260, USA.
Ophthalmology. 2011 Apr;118(4):725-9. doi: 10.1016/j.ophtha.2010.08.012. Epub 2010 Oct 29.
To assess 5-year Descemet's stripping endothelial keratoplasty (DSEK) graft survival and endothelial cell loss in the surviving grafts.
Retrospective, interventional case series.
One hundred sixty-five eyes of 149 patients treated with primary DSEK.
Donor corneal-scleral rims were dissected manually or with a microkeratome and were cut with a trephine. The graft was folded endothelial side inward and was inserted with forceps through a 5-mm incision. The cumulative probability of secondary graft failure was calculated using Kaplan-Meier survival analysis and the log-rank test. Endothelial cell density (ECD) was determined from baseline preoperative donor and 1-year, 3-year, and 5-year postoperative central endothelial images.
Graft survival and ECD at 5 years.
The median recipient age was 71 years (range, 22-90 years) and 62% were female. Eighteen eyes (11%) were treated for pseudophakic or aphakic corneal edema and 147 eyes (89%) were treated for Fuchs' dystrophy. The cumulative 5-year survival rate was significantly lower in pseudophakic or aphakic corneal edema eyes (76%) versus Fuchs' eyes (95%; P = 0.0087). In particular, the 5-year survival rate was reduced significantly in eyes with prior glaucoma shunt or trabeculectomy surgery vs. those without (40% vs. 95%; P<0.0001). The causes of secondary graft failure were endothelial decompensation in 6 eyes (3.6%) and unsatisfactory corrected distance acuity (20/60 to 20/100) in 4 eyes (2.4%). No grafts experienced traumatic wound rupture or failed as a result of ocular surface complications. The median 5-year endothelial cell loss was 53% (range, 7.5%-89%). The 5-year graft ECD was correlated weakly with the baseline donor ECD (r = 0.22 and P = 0.04) and was not significantly correlated with recipient gender (P = 0.075), age (P = 0.85), or diagnosis (P = 0.78).
The 5-year graft survival rates for DSEK were similar to those reported for penetrating keratoplasty in the multicenter Cornea Donor Study (95% vs. 93% for Fuchs' dystrophy and 76% vs. 73% for pseudophakic or aphakic corneal edema). Furthermore, the 5-year endothelial cell loss after DSEK compared favorably with that measured after penetrating keratoplasty in the Cornea Donor Study (53% vs. 70%).
评估 5 年的去表皮角膜内皮移植术（DSEK）移植物存活率和存活移植物中的内皮细胞丢失。
回顾性、干预性病例系列。
149 名患者的 165 只眼接受了原发性 DSEK 治疗。
手动或使用微型角膜刀分离供体角膜 - 巩膜边缘，并使用环钻切割。移植物将内皮侧向内折叠，并通过 5mm 的切口用镊子插入。使用 Kaplan-Meier 生存分析和对数秩检验计算继发性移植物失败的累积概率。从基线术前供体和 1 年、3 年和 5 年术后中央内皮图像中确定内皮细胞密度（ECD）。
5 年移植物存活率和 ECD。
中位受者年龄为 71 岁（范围，22-90 岁），62%为女性。18 只眼（11%）因白内障或无晶状体性角膜水肿而接受治疗，147 只眼（89%）因 Fuchs 营养不良而接受治疗。白内障或无晶状体性角膜水肿眼的 5 年累积存活率明显低于 Fuchs 眼（76%比 95%；P=0.0087）。特别是，有青光眼分流或小梁切除术史的眼与无史的眼相比，5 年存活率显著降低（40%比 95%；P<0.0001）。继发性移植物失败的原因是内皮失代偿 6 只眼（3.6%）和矫正视力不满意（20/60 至 20/100）4 只眼（2.4%）。没有移植物因创伤性伤口破裂或眼表并发症而失败。中位 5 年内皮细胞丢失为 53%（范围，7.5%-89%）。5 年移植物 ECD 与基线供体 ECD 呈弱相关（r=0.22，P=0.04），与受者性别（P=0.075）、年龄（P=0.85）或诊断（P=0.78）无显著相关性。
DSEK 的 5 年移植物存活率与多中心角膜供体研究报告的穿透性角膜移植术相似（Fuchs 营养不良为 95%比 93%，白内障或无晶状体性角膜水肿为 76%比 73%）。此外，DSEK 后 5 年的内皮细胞丢失与角膜供体研究中测量的穿透性角膜移植术相比具有优势（53%比 70%）。
