接受后弹力层剥除自动内皮角膜移植术的富克斯营养不良患者的术后视力：与组织学改变严重程度的相关性
Postoperative visual acuity in patients with fuchs dystrophy undergoing descemet membrane-stripping automated endothelial keratoplasty: correlation with the severity of histologic changes.
作者信息
Happ Dorrie M, Lewis David A, Eng Kevin H, Potter Heather D, Neekhra Aneesh, Croasdale Christopher R, Hardten David R, Nehls Sarah, Eide Michael, Rowe Jocelyn, Khedr Sherif, Albert Daniel M
机构信息
Duluth Family Medicine Residency Program, Duluth, Minnesota, USA.
出版信息
Arch Ophthalmol. 2012 Jan;130(1):33-8. doi: 10.1001/archophthalmol.2011.375.
OBJECTIVE
To investigate a correlation between the severity of histologic changes of the Descemet membrane in patients with Fuchs endothelial dystrophy and the best-corrected visual acuity (VA) after Descemet membrane-stripping automated endothelial keratoplasty (DSAEK).
METHODS
In a retrospective study design, we created a histologic grading system based on common characteristics observed histologically among 92 DSAEK specimens sent to the University of Wisconsin Eye Pathology Laboratory with a clinical diagnosis of Fuchs dystrophy from 3 separate corneal surgeons. Cases were graded as mild, moderate, or severe on the basis of guttae dispersion, presence of a laminated Descemet membrane, presence of embedded guttae, and density of guttae. Regression models were built to study the relationship among preoperative VA, histologic findings, and best-corrected VA 6 months and 1 and 2 years after DSAEK.
RESULTS
No correlation was found between the severity of histologic changes of Descemet membrane and preoperative VA. However, a correlation was noted between the preoperative and final VA. Cases with a laminated Descemet membrane but no embedded guttae (n = 8) appeared to be less responsive to DSAEK. Otherwise, the severity of histologic changes of Descemet membrane observed in patients with Fuchs corneal dystrophy after DSAEK did not show a statistically significant correlation with final VA.
CONCLUSIONS
Our analysis fails to show an inverse relationship between the severity of histologic changes of the Descemet membrane and the best-corrected VA of at least 20/40 after DSAEK for Fuchs endothelial dystrophy. However, in a subset of patients with Fuchs dystrophy who develop a laminated Descemet membrane without embedded guttae, the visual recovery after DSAEK is less than expected. The laminated architecture of Descemet membrane without embedded guttae may facilitate separation between the membrane layers and, thus, incomplete removal of the recipient's Descemet membrane during DSAEK, which may then limit the postoperative visual outcome.
目的
探讨富克斯内皮营养不良患者后弹力层组织学改变的严重程度与后弹力层剥除自动内皮角膜移植术（DSAEK）后最佳矫正视力（VA）之间的相关性。
方法
在一项回顾性研究设计中，我们基于从3位不同角膜外科医生处送至威斯康星大学眼病理实验室、临床诊断为富克斯营养不良的92份DSAEK标本的组织学常见特征，创建了一个组织学分级系统。根据角膜小滴的分散情况、分层后弹力层的存在、嵌入角膜小滴的存在以及角膜小滴的密度，将病例分为轻度、中度或重度。构建回归模型以研究术前视力、组织学结果以及DSAEK后6个月、1年和2年的最佳矫正视力之间的关系。
结果
未发现后弹力层组织学改变的严重程度与术前视力之间存在相关性。然而，术前和最终视力之间存在相关性。有分层后弹力层但无嵌入角膜小滴的病例（n = 8）似乎对DSAEK的反应较小。否则，富克斯角膜营养不良患者DSAEK后观察到的后弹力层组织学改变的严重程度与最终视力之间未显示出统计学上的显著相关性。
结论
我们的分析未能显示富克斯内皮营养不良患者DSAEK后后弹力层组织学改变的严重程度与至少20/40的最佳矫正视力之间存在反比关系。然而，在一部分出现分层后弹力层且无嵌入角膜小滴的富克斯营养不良患者中，DSAEK后的视力恢复低于预期。无嵌入角膜小滴的后弹力层分层结构可能有助于膜层之间的分离，从而在DSAEK期间受体后弹力层的不完全去除，这可能会限制术后视力结果。
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