分离性角膜移植术：供体组织分离后的储存时间与结果的关系。
Split cornea transplantation: relationship between storage time of split donor tissue and outcome.
机构信息
Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.
出版信息
Ophthalmology. 2013 May;120(5):899-907. doi: 10.1016/j.ophtha.2012.11.012. Epub 2013 Feb 8.
PURPOSE
To analyze the relationship between storage time of split donor tissue and outcomes after deep anterior lamellar keratoplasty (DALK) and Descemet's membrane endothelial keratoplasty (DMEK).
DESIGN
Retrospective analysis of a nonrandomized, consecutive, interventional case series.
PARTICIPANTS
One hundred ten eyes with anterior stromal disease suitable for DALK and 110 eyes with endothelial disease suitable for DMEK underwent surgically successful split cornea transplantation combining both procedures within 7 days after splitting.
METHODS
Split donor storage times (splitting to grafting) and total storage times (death to grafting) were correlated with the 1-year functional and morphologic outcomes after DALK and DMEK surgery using a Spearman correlation coefficient and a Mann-Whitney U test.
MAIN OUTCOME MEASURES
Best spectacle-corrected visual acuity (BSCVA), endothelial cell density, and complication rates within 12 months of follow-up.
RESULTS
The mean split donor storage time was 35 ± 47 hours (range, 0-162 hours) after splitting for anterior donor grafts and 21 ± 40 hours (range, 0-158 hours) for posterior grafts. The mean total storage time was 352 ± 108 hours (range, 108-678 hours) for anterior lamellas and 339 ± 109 hours (range, 96-630 hours) for posterior lamellas. One year after DALK, the mean BSCVA was 20/30 (range, 20/50-20/20), endothelial cell loss was 8% (range, 2%-16%), and the complication rate (Descemet's folds, epitheliopathy, loose sutures) was 18%. One year after DMEK, the mean BSCVA was 20/25 (range, 20/40-20/16), endothelial cell loss was 41% (range, 17%-63%), and the complication rate (partial graft detachment) was 62%. For DALK and DMEK, no significant association was observed between split donor storage time as well as total storage time and BSCVA (P ≥ 0.409), endothelial cell loss (P≥0.236), or complication rate (P ≥ 0.647) within 1 year of follow-up.
CONCLUSIONS
Anterior and posterior donor tissue may be stored safely for up to 1 week in organ culture before use in DALK and DMEK surgery. This simplifies the clinical feasibility of split cornea transplantation to reduce donor shortage and cost in corneal transplantation in the future.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
目的
分析分体供体组织的储存时间与深板层角膜移植术（DALK）和 Descemet 膜内皮角膜移植术（DMEK）后结果之间的关系。
设计
回顾性、非随机、连续、干预性病例系列研究。
参与者
110 只适合 DALK 的前部基质疾病眼和 110 只适合 DMEK 的内皮疾病眼在分体后 7 天内成功进行了联合手术的分体角膜移植。
方法
使用 Spearman 相关系数和 Mann-Whitney U 检验将分体供体的储存时间（分体至移植）和总储存时间（死亡至移植）与 DALK 和 DMEK 手术后 1 年的功能和形态结果相关联。
主要观察指标
最佳矫正视力（BSCVA）、内皮细胞密度和 12 个月随访期间的并发症发生率。
结果
前供体移植物的平均分体供体储存时间为 35 ± 47 小时（范围，0-162 小时），后供体移植物的平均分体供体储存时间为 21 ± 40 小时（范围，0-158 小时）。前板层的平均总储存时间为 352 ± 108 小时（范围，108-678 小时），后板层的平均总储存时间为 339 ± 109 小时（范围，96-630 小时）。DALK 术后 1 年，平均 BSCVA 为 20/30（范围，20/50-20/20），内皮细胞丢失 8%（范围，2%-16%），并发症发生率（Descemet 褶皱、上皮病、缝线松动）为 18%。DMEK 术后 1 年，平均 BSCVA 为 20/25（范围，20/40-20/16），内皮细胞丢失 41%（范围，17%-63%），并发症发生率（部分移植物脱离）为 62%。对于 DALK 和 DMEK，BSCVA（P≥0.409）、内皮细胞丢失（P≥0.236）或并发症发生率（P≥0.647）在 1 年随访期内均与分体供体储存时间和总储存时间无显著相关性。
结论
分体供体组织在前房和后房内可安全储存长达 1 周，以备在 DALK 和 DMEK 手术中使用。这简化了分体角膜移植术的临床可行性，以减少未来角膜移植中的供体短缺和成本。
利益披露
作者在本文讨论的任何材料中均无专有或商业利益。
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