101 只眼行 DSEK 术后的结果，这些眼之前曾行小梁切除术和引流管植入术。

Outcomes after DSEK in 101 eyes with previous trabeculectomy and tube shunt implantation.

机构信息

Jules Stein Eye Institute, David Geffen School of Medicine, The University of California, Los Angeles, CA.

出版信息

Cornea. 2014 Mar;33(3):223-9. doi: 10.1097/ICO.0000000000000028.

DOI:10.1097/ICO.0000000000000028

PMID:24322807

Abstract

PURPOSE

The aim of this study was to determine the outcomes after Descemet stripping endothelial keratoplasty (DSEK) in eyes with previous glaucoma surgery.

METHODS

This is a retrospective review of all DSEK procedures performed by 2 surgeons from May 1, 2006, to December 31, 2012.

RESULTS

Four hundred sixty-two DSEK procedures were performed, of which 113 (24%) were performed in 101 eyes after a trabeculectomy (52 procedures) and/or tube shunt implantation (76 procedures) (15 procedures in eyes with both). Primary graft failure and donor dislocation developed in 4.4% and 14.2% of cases in eyes with previous glaucoma surgery, not significantly different from the 3.2% (P = 0.56) and 11.5% (P = 0.51) in eyes without prior glaucoma surgery. During a mean follow-up of 20.7 ± 17.6 months, endothelial rejection developed in a greater percentage of eyes with previous glaucoma surgery (12.9%; 0.069/eye-year) compared with that in eyes without surgery (6.9%; 0.042/eye-year), although the difference was not statistically significant (P = 0.066 for percentage of eyes; P = 0.16 for rejection rate). Secondary graft failure developed in a significantly higher percentage of eyes with previous glaucoma surgery (15.9%; 0.094/eye-year) compared with that in eyes without surgery (3.2%; 0.019/eye-year) (P < 0.0001; P < 0.0001). Elevated intraocular pressure after DSEK was significantly more common in eyes with medically treated glaucoma (41.3%; 0.345/eye year) than in eyes with a previous glaucoma surgery (23.8%; 0.145/eye-year) and without glaucoma (20.0%; 0.138/eye year) (P = 0.009; P = 0.007).

CONCLUSIONS

Although intraoperative and early postoperative complications such as donor dislocation and primary graft failure are not significantly more common after DSEK in eyes with previous glaucoma surgery, secondary graft failure is. In contrast, other postoperative complications such as elevated intraocular pressure are significantly more common in eyes with medically treated glaucoma than in eyes with previous glaucoma surgery and without glaucoma.

摘要

目的

本研究旨在评估在青光眼手术治疗之后行撕囊内皮角膜移植术（DSEK）的术后结果。

方法

这是一项回顾性研究，纳入了两位外科医生在 2006 年 5 月 1 日至 2012 年 12 月 31 日期间施行的所有 DSEK 手术。

结果

共施行 462 例 DSEK 手术，其中 113 例（24%）在小梁切除术（52 例）和/或引流管植入术（76 例）后施行（15 例在双眼施行）。在有青光眼手术史的眼中，原发性移植物失功和供体脱位的发生率分别为 4.4%和 14.2%，与无青光眼手术史的眼中的 3.2%（P=0.56）和 11.5%（P=0.51）无显著差异。在平均 20.7±17.6 个月的随访中，有青光眼手术史的眼中内皮排斥反应的发生率更高（12.9%；0.069/眼年），虽然差异无统计学意义（眼发生率的差异 P=0.066；排斥率的差异 P=0.16），但显著高于无手术史的眼中（6.9%；0.042/眼年）。在有青光眼手术史的眼中，继发性移植物失功的发生率显著高于无手术史的眼中（15.9%；0.094/眼年）（P<0.0001；P<0.0001）。与无青光眼的眼中（20.0%；0.138/眼年）相比，在接受药物治疗的青光眼眼中（41.3%；0.345/眼年），DSEK 术后发生高眼压的情况更常见（P=0.009；P=0.007）。