Roberts Harry W, Mukherjee Achyut, Aichner Heidi, Rajan Madhavan S
*Cataract and Cornea Service, Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge, United Kingdom; and †Vision and Eye Research Unit (VERU), Postgraduate Medical Institute, Anglia Ruskin University, Cambridge, United Kingdom.
Cornea. 2015 Nov;34(11):1345-50. doi: 10.1097/ICO.0000000000000596.
To evaluate visual outcomes, endothelial graft thickness, and complications in microthin Descemet stripping automated endothelial keratoplasty (DSAEK).
A prospective interventional cohort of 130 eyes of 114 consecutive patients underwent microthin DSAEK. Endothelial graft preparation included pachymetry-controlled stromal dehydration to reduce donor thickness between 550 and 530 μm by a custom airflow device, before a single-pass microkeratome dissection with a uniform cutting head of 350 μm to achieve microthin endothelial grafts (<130 μm). Data on visual acuity, graft thickness, endothelial cell loss, and complication rates were analyzed.
Pachymetry-controlled donor preconditioning reduced donor thickness on average by 67 μm (range 0-186, SD 44.7) from 590 μm (range 485-806, SD 53) to 528 μm (range 480-620, SD 23), P < 0.01, and allowed graft preparation without any case of intraoperative graft loss or perforation. The resultant mean graft thickness was 94 μm (SD 25) intraoperatively, 94 μm (SD 26) at 1 month, and 90 μm (SD 19) at 12 months. Of note, 98.2% of eyes without significant visual comorbidity achieved best-corrected Snellen acuity of 6/9 or more at 12 months. There was a 35.8% and 41% reduction in endothelial cell density at 3 and 12 months, respectively. Postoperative graft detachment occurred in 5% of cases (1.7% in uncomplicated eyes). There was no graft loss during preparation, and none developed immune rejection during the study period.
The microthin DSAEK procedure offers a simple and safe technique to prepare thin endothelial grafts with a low risk of graft wastage, low risk of postoperative detachment, and visual results that are comparable to those of other thin endothelial keratoplasty procedures.
评估超薄Descemet膜剥离自动内皮角膜移植术（DSAEK）的视觉效果、内皮移植片厚度及并发症。
对114例连续患者的130只眼进行前瞻性干预队列研究，实施超薄DSAEK。内皮移植片制备包括通过定制气流装置进行测厚控制的基质脱水，以使供体厚度在550至530μm之间降低，然后用350μm的统一切割头进行单次微型角膜刀切割，以获得超薄内皮移植片（<130μm）。分析视力、移植片厚度、内皮细胞丢失及并发症发生率的数据。
测厚控制的供体预处理使供体厚度平均从590μm（范围480 - 806，标准差53）降至528μm（范围480 - 620，标准差23），减少了67μm（范围0 - 186，标准差44.7），P < 0.01，并使移植片制备过程中无术中移植片丢失或穿孔情况发生。术中所得平均移植片厚度为94μm（标准差25），1个月时为94μm（标准差26），12个月时为90μm（标准差19）。值得注意的是, 98.2%无明显视力合并症的眼在12个月时最佳矫正视力达到6/9或更好。3个月和12个月时内皮细胞密度分别降低了35.8%和41%。术后移植片脱离发生率为5%（无并发症的眼中为1.7%）。制备过程中无移植片丢失，研究期间也无免疫排斥发生。
超薄DSAEK手术提供了一种简单安全的技术来制备薄内皮移植片，移植片浪费风险低，术后脱离风险低，视觉效果与其他薄内皮角膜移植手术相当。
