Department of Ophthalmology, University of Cologne, Kerpenerstraße 62, 50924, Cologne, Germany,
Graefes Arch Clin Exp Ophthalmol. 2013 Sep;251(9):2181-5. doi: 10.1007/s00417-013-2434-0. Epub 2013 Aug 2.
When performing ultra-thin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK), the quality of the stromal interface and stromal thickness seem to be critical for visual outcome. The aim of this study was to investigate whether additional osmotic deswelling prior to UT-DSAEK improves the quality of the cut surface and leads to a more reliable and deeper cut in UT-DSAEK ("OSMO-UT-DSAEK").
Seventeen human donor corneas not usable for transplantation were used in this experiment. After standard deswelling with culture Medium II, ten corneas were randomly assigned to be additionally deswollen within THIN-C medium. The other remaining seven corneas were put back into culture Medium II. All corneas were placed in an artificial anterior chamber system (Moria); a double path cutting procedure using a microkeratome (Moria) was then performed. Corneal thickness was measured by ultrasound biomicroscopy and in paraffin-embedded slides, followed by histological grading of the cut surface.
Stromal interface smoothness significantly improved after preconditioning in THIN-C medium (Pearson P = 0.019). The correlation of the corneal thickness obtained by UBM (mean 706 ± SD 208 μm) and histology (mean 530 ± SD 159 μm) was not significant (Pearson r = 0.11, P > 0.05, mean difference 247, 95 % CI [+50;+304]). We found no significant correlation between the microkeratome setting and the actual thickness of the lenticule measured in histological analysis in both media as well as for the first and second cut (first cut: Pearson r = 0.9, P = 0.1, 95 % CI [-10;+96], second cut: Pearson r = 0.9, P = 0.4, 95 % CI [-10;+22]).
Preconditioning of corneas with THIN-C medium significantly improved the quality of the graft interface in UT-DSAEK, but did not significantly improve the cut precision of the microkeratome.
在进行超薄 Descemet 撕囊自动化内皮角膜移植术（UT-DSAEK）时，基质界面的质量和基质厚度似乎对视力结果至关重要。本研究旨在探讨在进行 UT-DSAEK 之前是否进行额外的渗透膨胀去水预处理（UT-DSAEK 中进行 OSMO）是否能改善切削面的质量，并导致更可靠和更深的切削。
本实验使用了 17 个人体供体角膜，这些角膜不能用于移植。在使用培养介质 II 进行标准去水膨胀后，将 10 个角膜随机分配到另外的 THIN-C 介质中去水膨胀。其余 7 个角膜则放回培养介质 II 中。所有角膜均被置于人工前房系统（Moria）中；然后使用微角膜刀（Moria）进行双路径切割程序。通过超声生物显微镜和石蜡嵌入切片测量角膜厚度，随后对切削面进行组织学分级。
在 THIN-C 介质中预处理后，基质界面的光滑度显著改善（Pearson P = 0.019）。通过 UBM（平均 706 ± 208 μm）和组织学（平均 530 ± 159 μm）获得的角膜厚度之间的相关性不显著（Pearson r = 0.11，P > 0.05，平均差异 247，95%置信区间 [+50；+304]）。我们发现，在两种介质中，以及在第一次和第二次切割时，微角膜刀设置与组织学分析中测量的实际镜片厚度之间均没有显著相关性（第一次切割：Pearson r = 0.9，P = 0.1，95%置信区间 [-10；+96]，第二次切割：Pearson r = 0.9，P = 0.4，95%置信区间 [-10；+22]）。
用 THIN-C 介质预处理角膜可显著改善 UT-DSAEK 中的移植物界面质量，但并未显著提高微角膜刀的切割精度。
