Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
Am J Ophthalmol. 2012 Jun;153(6):1091-8.e2. doi: 10.1016/j.ajo.2011.12.014. Epub 2012 Mar 6.
To compare the outcomes of trabeculectomy surgery after Descemet stripping automated endothelial keratoplasty (DSAEK) to penetrating keratoplasty (PK).
Retrospective case-control study.
Patients within an institutional setting who underwent trabeculectomy with mitomycin C (MMC) for uncontrolled elevated intraocular pressure (IOP) after corneal graft surgery were included. Patients with pre-existing glaucoma were excluded. Twenty patients with trabeculectomy after DSAEK and 41 patients with trabeculectomy after PK were analyzed. The main outcome measure was IOP control at 12 months. Secondary outcome measures were postoperative interventions including reinstatement of IOP-lowering medications, bleb needling with 5-fluorouracil (5FU) or further glaucoma surgery, and the incidence of complications related to trabeculectomy and/or corneal graft surgery.
There was no difference in pre-trabeculectomy IOP between DSAEK vs PK group (35.5 ± 10.1 vs 32.9 ± 8.9, P = .31). At 12 months after trabeculectomy, mean IOP in the DSAEK group was lower compared to the PK controls (10.6 ± 3.2 vs 14.6 ± 8.5, P = .04). The proportion of patients who achieved an IOP less than 12 mm Hg was significantly higher in the DSAEK group (80.0% vs 48.6%, P = .03). The proportions of eyes that required intervention after trabeculectomy were comparable between the 2 groups (DSAEK vs PK, all interventions: 20.0% vs 39.5%, P = .15; IOP-lowering medications required: 15.0% vs 39.5%, P = .08; needling with 5FU: 20.0% vs 23.7%, P > .99; further glaucoma surgery: 0% vs 13.2%, P = .15). Corneal graft failure arising after trabeculectomy was seen in 10.0% of DSAEK cases and in 10.5% of PK controls (P = 1.0).
Compared to trabeculectomy after PK, trabeculectomy after DSAEK achieved lower mean IOP at 12 months, and a larger proportion of DSAEK patients achieved an IOP of less than 12 mm Hg. There was no difference in the need for intervention after trabeculectomy, or incidence of other complications. Trabeculectomy is an effective surgical procedure for the management of postgraft ocular hypertension in DSAEK patients, and DSAEK may have an advantage in terms of success of trabeculectomy surgery over PK.
比较穿透性角膜移植术（PK）后行 Descemet 膜撕除自动内皮角膜移植术（DSAEK）与小梁切除术治疗植片相关青光眼的疗效。
回顾性病例对照研究。
本研究纳入了在机构环境下因角膜移植术后眼压控制不佳而行小梁切除术联合丝裂霉素 C（MMC）治疗的患者。排除术前即患有青光眼的患者。分析了 20 例行 DSAEK 后小梁切除术和 41 例行 PK 后小梁切除术的患者。主要观察指标为术后 12 个月时眼压控制情况。次要观察指标包括再次使用降眼压药物、5-氟尿嘧啶（5FU）巩膜下注射或进一步行青光眼手术等术后干预措施，以及与小梁切除术和/或角膜移植术相关的并发症发生率。
DSAEK 组与 PK 组患者术前眼压差异无统计学意义（35.5 ± 10.1 比 32.9 ± 8.9，P =.31）。小梁切除术后 12 个月时，DSAEK 组患者平均眼压较 PK 对照组低（10.6 ± 3.2 比 14.6 ± 8.5，P =.04）。DSAEK 组患者眼压<12 mmHg 的比例明显高于 PK 对照组（80.0%比 48.6%，P =.03）。两组患者术后干预的比例差异无统计学意义（DSAEK 组与 PK 组，所有干预：20.0%比 39.5%，P =.15；需要降眼压药物：15.0%比 39.5%，P =.08；5FU 巩膜下注射：20.0%比 23.7%，P>.99；进一步行青光眼手术：0%比 13.2%，P =.15）。DSAEK 组有 10.0%的患者和 PK 对照组有 10.5%的患者出现小梁切除术后植片失败（P = 1.0）。
与 PK 后小梁切除术相比，DSAEK 后小梁切除术术后 12 个月时眼压平均水平更低，且 DSAEK 组患者眼压<12 mmHg 的比例更大。小梁切除术后干预需求或其他并发症发生率无差异。小梁切除术是治疗 DSAEK 术后植片相关高眼压的有效手术方法，与 PK 相比，DSAEK 可能在小梁切除术成功率方面具有优势。
