使用眼库制备组织的Descemet膜内皮角膜移植术的临床结果
Clinical outcomes of Descemet membrane endothelial keratoplasty using eye bank-prepared tissues.
作者信息
Deng Sophie X, Sanchez P James, Chen Luxia
机构信息
Cornea Division, Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California.
Cornea Division, Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California.
出版信息
Am J Ophthalmol. 2015 Mar;159(3):590-6. doi: 10.1016/j.ajo.2014.12.007. Epub 2014 Dec 17.
PURPOSE
To investigate the outcomes of Descemet membrane endothelial keratoplasty (DMEK) using prestripped donor tissue prepared by an eye bank.
DESIGN
Retrospective, noncomparative case series.
METHODS
This retrospective, noncomparative, observational study investigated the outcomes of the first 40 consecutive DMEK procedures performed by a single surgeon using prestripped tissues prepared by a single eye bank during the period September 17, 2013 to July 1, 2014. A new technique to unfold the Descemet membrane grafts using a single cannula was described. Medical records were reviewed to obtain the prestripped and poststripped endothelial cell counts (ECC), postoperative ECC, visual acuity measurements, and complications.
RESULTS
Of the 43 prestripped tissues received, 40 were transplanted. The leading indications for DMEK were Fuchs endothelial corneal dystrophy (n = 28) and bullous keratopathy (n = 11). Nine DMEK procedures were performed in combination with phacoemulsification and posterior chamber intraocular lens implantation. Six patients had undergone prior glaucoma surgeries. The mean follow-up duration was 5.3 months (range, 1 week to 11 months). Preoperative spectacle-corrected visual acuity was ≤20/200 in 8 patients (20%) and ≤20/40 in 37 patients (92.5%). Primary graft failure occurred in the first case. Thirty-eight patients had improved vision postoperatively. Among the 39 patients who had successful DMEK, postoperative BCVA was ≥20/20 in 20 patients (51.2%), ≥20/25 in 30 patients (76.9%), and ≥20/40 in 34 patients (87.2%) by the last follow-up. There was no secondary graft failure. Rejection occurred in 2 patients because of self-discontinuation of topical corticosteroid. The most common complication was partial detachment requiring air injection (11 of 40 patients; 27.5%). Mean ECC loss after stripping of Descemet membrane was 3.9% (range, 6.5% gain to 14.5% loss). During the first 6 months after transplantation, the average ECC loss was 30.5% (range, 3.8%-67.4% loss).
CONCLUSIONS
DMEK using eye bank-prepared tissue achieved outcomes comparable to those reported for DMEK using surgeon-prepared tissue.
目的
研究使用眼库制备的预剥离供体组织进行Descemet膜内皮角膜移植术（DMEK）的效果。
设计
回顾性、非对比性病例系列研究。
方法
这项回顾性、非对比性观察性研究调查了2013年9月17日至2014年7月1日期间，一名外科医生使用单一眼库制备的预剥离组织连续进行的前40例DMEK手术的效果。描述了一种使用单根套管展开Descemet膜移植物的新技术。查阅病历以获取预剥离和后剥离的内皮细胞计数（ECC）、术后ECC、视力测量结果及并发症情况。
结果
在收到的43份预剥离组织中，40份进行了移植。DMEK的主要适应证为Fuchs内皮角膜营养不良（n = 28）和大疱性角膜病变（n = 11）。9例DMEK手术与白内障超声乳化吸除及后房型人工晶状体植入联合进行。6例患者曾接受过青光眼手术。平均随访时间为5.3个月（范围1周～11个月）。术前矫正视力≤20/200的患者有8例（20%），≤20/40的患者有37例（92.5%）。第一例发生了原发性移植物失败。38例患者术后视力提高。在39例DMEK手术成功的患者中，末次随访时最佳矫正视力（BCVA）≥20/20的患者有20例（51.2%），≥20/25的患者有30例（76.9%），≥20/40的患者有34例（87.2%）。未发生继发性移植物失败。2例患者因自行停用局部皮质类固醇激素而发生排斥反应。最常见的并发症是需要注入空气的部分脱离（40例患者中有11例；27.5%）。Descemet膜剥离后的平均ECC损失为3.9%（范围从增加6.5%到损失14.5%）。移植后的前6个月，平均ECC损失为30.5%（范围3.8%～67.4%）。
结论
使用眼库制备的组织进行DMEK的效果与使用外科医生制备的组织进行DMEK所报告的效果相当。
Zotero 插件