Cornea Service, Wills Eye Institute, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
Cornea. 2013 Aug;32(8):1083-8. doi: 10.1097/ICO.0b013e31828ea02a.
To compare the visual outcomes and complications after Descemet stripping endothelial keratoplasty (DSEK) and penetrating keratoplasty (PK) in the same set of patients.
Fifteen patients underwent PK in 1 eye and DSEK in the fellow eye for Fuchs endothelial dystrophy at the Wills Eye Institute from 1993 to 2011.
Mean postoperative best-corrected visual acuity in the PK and DSEK groups (0.39 ± 0.39 and 0.23 ± 0.12 logarithm of the minimum angle of resolution, respectively) was statistically significantly better than mean preoperative best-corrected visual acuity (0.83 ± 0.36 and 0.76 ± 0.34 logarithm of the minimum angle of resolution, respectively) (P < 0.025 and P < 0.001, respectively). Mean manifest refraction cylinder was higher in the PK eyes than in the DSEK eyes at 1 year [3.58 ± 1.82 and 1.23 ± 1.63 diopter (D), respectively] and at 2 years of follow-up (3.57 ± 1.81 and 1.05 ± 1.18 D, respectively) (P < 0.001) but was not statistically different at the last visit (3.18 ± 2.67 and 1.5 ± 1.66 D, respectively) (P = 0.052). Mean postoperative follow-up was 101.9 ± 39.5 and 29.9 ± 19.9 months after PK and DSEK, respectively. Most common complications after PK were high astigmatism in 15 eyes, monocular diplopia in 7 eyes, posterior capsule opacity in 6 eyes, and secondary glaucoma and graft rejection episodes in 5 eyes each. After DSEK, secondary glaucoma in 3 eyes and graft rejection in 2 eyes were the most common complications.
Final visual outcomes were not statistically different between the 2 procedures, but DSEK had early visual stabilization and PK had a more complicated course, with more astigmatism, rejections, suture-related infections, and graft failures.
比较同一批患者中进行的撕囊式内皮角膜移植术（DSEK）和穿透性角膜移植术（PK）的术后视力结果和并发症。
1993 年至 2011 年，在威尔斯眼研究所，15 名 Fuchs 内皮营养不良患者的一只眼接受了 PK，另一只眼接受了 DSEK。
PK 组和 DSEK 组的术后最佳矫正视力（分别为 0.39 ± 0.39 和 0.23 ± 0.12 最小分辨角对数）均明显优于术前最佳矫正视力（分别为 0.83 ± 0.36 和 0.76 ± 0.34 最小分辨角对数）（P < 0.025 和 P < 0.001）。在 1 年和 2 年的随访中，PK 眼的角膜散光均高于 DSEK 眼（分别为 3.58 ± 1.82 和 1.23 ± 1.63 屈光度（D），P < 0.001），但在末次随访时无统计学差异（分别为 3.18 ± 2.67 和 1.5 ± 1.66 D，P = 0.052）。PK 和 DSEK 后的平均术后随访时间分别为 101.9 ± 39.5 和 29.9 ± 19.9 个月。PK 后最常见的并发症是 15 只眼出现高度散光，7 只眼出现单眼复视，6 只眼出现后囊混浊，5 只眼分别出现继发性青光眼和移植物排斥反应。DSEK 后，3 只眼出现继发性青光眼，2 只眼出现移植物排斥反应。
两种手术的最终视力结果无统计学差异，但 DSEK 术后视力恢复较快，PK 术后散光较多，且更易出现排斥反应、缝线相关感染和移植物失败。
