Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
PLoS One. 2013 Aug 16;8(8):e72089. doi: 10.1371/journal.pone.0072089. eCollection 2013.
To evaluate the outcomes of Descemet-stripping automated endothelial keratoplasty (DSAEK) with the use of continuous air pumping technique in Asian eyes with previous Ahmed glaucoma valve implantation.
The DSAEK procedure was modified in that complete air retention of the anterior chamber was maintained for 10 min using continuous air pumping at 30 mm Hg. The primary outcome measurement was graft survival, and postoperative clinical features including, rate of graft detachment, endothelial cell count, intraocular pressure (IOP), surgical time and cup/disc ratio were also recorded.
A total of 13 eyes of 13 patients which underwent modified DSAEK and 6 eyes of 6 patients which underwent conventional DSAEK were included. There was a significant difference in graft survival curves between two groups (P = 0.029); the 1-year graft survival rates were estimated as 100% and 66.7% for patients with modified DSAEK and those with traditional DSAEK, respectively. The rate of graft detachment were 0% and 33.3% for the modified DSAEK and conventional DSAEK groups, respectively (P = 0.088). The significantly lowered surgical time for air tamponade was noted in the modified DSAEK group compared to that in the conventional DSAEK group [median (IQR): 10.0 (10.0, 10.0) min vs. 24.5 (22.0, 27.0) min; P<0.001] Postoperatively, patients in the modified DSAEK group had significantly lower IOP as compared to the conventional DSAEK group [12.0 (11.0, 15.0) mm Hg vs. 16.0 (15.0, 18.0) mm Hg; P = 0.047]. Modified DSAEK patients had higher endothelial cell counts as compared to conventional DSAEK patients [2148.0 (1964.0, 2218.0) vs. 1529.0 (713.0, 2014.0)], but the difference did not reach statistical significance (P = 0.072).
New continuous air pumping technique in DSAEK can be performed safely and effectively in patients with prior GDDs placement who have corneal failure.
评估在亚洲人眼内使用连续空气泵注技术进行 Descemet 膜撕除内皮角膜移植术（DSAEK）的效果，这些患者之前曾接受 Ahmed 青光眼引流阀植入术。
DSAEK 手术进行了改良，使用 30mmHg 的连续空气泵注保持前房完全空气滞留 10 分钟。主要观察指标为移植物存活率，术后临床特征包括移植物脱离率、内皮细胞计数、眼内压（IOP）、手术时间和杯/盘比。
共纳入 13 例（13 只眼）行改良 DSAEK 患者和 6 例（6 只眼）行传统 DSAEK 患者。两组移植物存活率曲线有显著差异（P=0.029）；改良 DSAEK 组和传统 DSAEK 组 1 年移植物存活率分别估计为 100%和 66.7%。改良 DSAEK 组和传统 DSAEK 组的移植物脱离率分别为 0%和 33.3%（P=0.088）。改良 DSAEK 组空气填充的手术时间明显短于传统 DSAEK 组[中位数（IQR）：10.0（10.0，10.0）min 比 24.5（22.0，27.0）min；P<0.001]。术后，改良 DSAEK 组患者的 IOP 明显低于传统 DSAEK 组[12.0（11.0，15.0）mmHg 比 16.0（15.0，18.0）mmHg；P=0.047]。改良 DSAEK 组患者的内皮细胞计数明显高于传统 DSAEK 组[2148.0（1964.0，2218.0）比 1529.0（713.0，2014.0）]，但差异无统计学意义（P=0.072）。
对于有角膜衰竭且之前曾接受过 GDD 植入术的患者，新的 DSAEK 中连续空气泵注技术可安全有效地进行。
