Hong Jing, Hao Yan-Sheng, Ma Zhi-Zhong, Peng Rong-Mei, Qu Hong-Qiang
Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China.
Zhonghua Yan Ke Za Zhi. 2011 Jan;47(1):11-6.
To evaluate the effect and explore the complications of Descemet-stripping automated endothelial keratoplasty (DSAEK) combined with phacoemulsification cataract surgery or lens exchange in corneal endothelial dysfunction eyes with lens disorders.
Retrospective case series. Eighteen consecutive cases (20 eyes) were performed DSAEK combined with lens surgery from December 2007 to December 2008 in Department of Ophthalmology, Peking University Third Hospital. Five cases (7 eyes) were performed DSAEK combined with phacoemulsification and intraocular lens (IOL) insertion. Seven cases were combined with anterior chamber IOL extraction, anterior vitrectomy and posterior chamber IOL insertion. Six aphakia cases were performed with DSAEK combined with anterior vitrectomy and sclera fixation posterior chamber IOL insertion. Postoperatively, the visual acuity, corneal transparency, central corneal thickness (CCT), endothelial cell density (ECD) and complications were observed during the follow-up.
The irritation was disappeared in all of patients. All of the corneas became transparent. The preoperative and postoperative mean CCT of the recipient beds was 859 µm and 553 µm respectively. T value was 5.303 (t = 5.303, P < 0.01). It was extremely significant difference. The mean ECD of the donors was 2987 cells/mm(2). The ECD was 1803 cells/mm(2) in three months postoperatively. The rate of endothelial cells loss was 41%. The visual acuity improved significantly except 9 eyes which had fundus disorders. Six eyes were better than 0.8. It was 55% in normal retinal function patients (6/11). The inflammatory reaction of the anterior chamber IOL eyes was most serious. Six eyes underwent graft dislocation. Five cases underwent high intraocular pressure. One case occurred graft rejection. These complications occurred in anterior chamber IOL eyes.
DSAEK combined with phacoemulsification cataract surgery or lens exchange is a safe and effective surgical treatment for corneal endothelial dysfunction with lens disorders. More complications occur in anterior chamber IOL eyes. DSAEK should be cautiously chosen in abnormal iris and chamber angle structural eyes.
评估角膜后弹力层剥除自动角膜内皮移植术（DSAEK）联合超声乳化白内障手术或晶状体置换术治疗合并晶状体病变的角膜内皮功能障碍眼的疗效，并探讨其并发症。
回顾性病例系列研究。2007年12月至2008年12月，北京大学第三医院眼科对18例（20只眼）患者行DSAEK联合晶状体手术。其中5例（7只眼）行DSAEK联合超声乳化白内障吸除及人工晶状体（IOL）植入术；7例联合前房型IOL取出、前部玻璃体切割及后房型IOL植入术；6例无晶状体眼行DSAEK联合前部玻璃体切割及巩膜固定后房型IOL植入术。术后随访观察视力、角膜透明度、中央角膜厚度（CCT）、内皮细胞密度（ECD）及并发症。
所有患者刺激症状消失，角膜均变透明。受体床术前及术后平均CCT分别为859μm和553μm，t值为5.303（t = 5.303，P < 0.01），差异具有极显著性。供体平均ECD为2987个细胞/mm²，术后3个月ECD为1803个细胞/mm²，内皮细胞丢失率为41%。除9只眼底病变眼外，视力均显著提高。6只眼视力优于0.8，视网膜功能正常患者中占55%（6/11）。前房型IOL眼的炎症反应最严重。6只眼发生植片脱位，5例发生高眼压，1例发生植片排斥反应。这些并发症均发生在前房型IOL眼。
DSAEK联合超声乳化白内障手术或晶状体置换术是治疗合并晶状体病变的角膜内皮功能障碍的一种安全有效的手术方法。前房型IOL眼并发症较多。虹膜及房角结构异常的眼应谨慎选择DSAEK手术。
