Ang Marcus, Mehta Jodhbir S, Anshu Arundhati, Wong Hon Kiat, Htoon Hla M, Tan Donald
Singapore National Eye Centre, Singapore.
Clin Ophthalmol. 2012;6:537-44. doi: 10.2147/OPTH.S26343. Epub 2012 Apr 3.
The purpose of this study was to compare endothelial cell counts after Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty in Asian eyes.
This was a retrospective study of patients from our prospective Singapore Corneal Transplant Study cohort who received corneal transplantation in 2006-2008. We compared eyes that underwent DSAEK or penetrating keratoplasty for Fuchs' endothelial dystrophy or pseudophakic and aphakic bullous keratopathy. Clinical data, and donor and recipient characteristics were recorded. Of 241 patients who met our inclusion criteria, 68 underwent DSAEK and 173 underwent penetrating keratoplasty. The main outcome measure was endothelial cell loss at 1 year. Secondary outcome measures were graft survival and visual outcomes at 1-year follow-up.
There were no significant differences in baseline characteristics of patients between the treatment groups. Percent endothelial cell loss at 1-year follow-up was greater in penetrating keratoplasty eyes (40.9% ± 2.9%) compared with DSAEK eyes (22.4% ± 2.3%; P < 0.001). DSAEK-treated eyes had significantly superior uncorrected visual acuity (mean difference = 0.42 ± 0.0059; P < 0.001) and best spectacle-corrected visual acuity (mean difference = 0.14 ± 0.032; P < 0.001) as compared with penetrating keratoplasty-treated eyes. Penetrating keratoplasty-treated eyes had worse astigmatism as compared with DSAEK-treated eyes (-3.0 ± 2.1 versus -1.7 ± 0.8; P < 0.001). Graft survival at 1 year was comparable in both groups, ie, 66/68 (97.0%) DSAEK-treated eyes versus 158/173 (92.0%) of penetrating keratoplasty-treated eyes had clear grafts (P = 0.479).
We report lower percent endothelial cell loss comparing DSAEK and penetrating keratoplasty at 1-year follow-up in Asian eyes, with comparable graft survival rates in both groups.
本研究旨在比较亚洲人眼中，后弹力层剥除自动角膜内皮移植术（DSAEK）和穿透性角膜移植术后的内皮细胞计数。
这是一项对我们前瞻性新加坡角膜移植研究队列中2006 - 2008年接受角膜移植的患者进行的回顾性研究。我们比较了因富克斯内皮营养不良或人工晶状体眼及无晶状体眼大泡性角膜病变而接受DSAEK或穿透性角膜移植的眼睛。记录了临床数据以及供体和受体的特征。在241名符合我们纳入标准的患者中，68人接受了DSAEK，173人接受了穿透性角膜移植。主要观察指标是1年时的内皮细胞丢失情况。次要观察指标是1年随访时的植片存活率和视力结果。
治疗组患者的基线特征无显著差异。穿透性角膜移植术组眼睛在1年随访时的内皮细胞丢失百分比（40.9% ± 2.9%）高于DSAEK组眼睛（22.4% ± 2.3%；P < 0.001）。与穿透性角膜移植术组眼睛相比，DSAEK治疗的眼睛在未矫正视力（平均差异 = 0.42 ± 0.0059；P < 0.001）和最佳矫正视力（平均差异 = 0.14 ± 0.032；P < 0.001）方面明显更优。与DSAEK治疗的眼睛相比，穿透性角膜移植术组眼睛的散光更严重（-3.0 ± 2.1对-1.7 ± 0.8；P < 0.001）。两组1年时的植片存活率相当，即DSAEK治疗的眼睛中有66/68（97.0%）植片清晰，穿透性角膜移植术治疗的眼睛中有158/173（92.0%）植片清晰（P = 0.479）。
我们报告在亚洲人眼中，DSAEK和穿透性角膜移植术在1年随访时，DSAEK的内皮细胞丢失百分比更低，两组的植片存活率相当。
