Ho Wang Yin G, Sampo M, Soare S, Hoffart L
Service d'ophtalmologie, université d'Aix-Marseille, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France; Équipe DiMABio, université d'Aix-Marseille, institut Fresnel, faculté des sciences de Saint-Jérôme, avenue Escadrille-Normandie-Niemen, 13397 Marseille cedex, France.
Service d'ophtalmologie, université d'Aix-Marseille, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
J Fr Ophtalmol. 2017 Jan;40(1):36-43. doi: 10.1016/j.jfo.2016.09.018. Epub 2017 Jan 6.
The purpose of our study was to evaluate the progression of lamellar corneal grafts after endothelial keratoplasty by Descemet stripping automated endothelial keratoplasty (DSAEK) and the effect of their characteristics on the clinical and functional results.
This was a prospective study in which 74 patients who had undergone endothelial keratoplasty by DSAEK were included. The corneal grafts were obtained from a French tissue bank and were delivered in a preservation medium containing a deturgescent agent (Corneajet or Stemalpha 3). Pachymetry of the corneal graft was measured ex vivo by ultrasonic pachymetry prior to dissection, then after the 1st or 2 cut as necessary. Corrected visual acuity in logMAR, total graft pachymetry, measured by anterior segment OCT (Spectralis HRA+SDOCT, Heidelberg engineering, Inc., Heidelberg, Germany) and corneal density (Pentacam, Oculus, Inc., Wetzlar, Germany) were obtained for each patient preoperatively, at D5, M1, M3, M6, M9 and M12.
Overall, 74 corneal grafts, from donors of mean age 69.7±13.3 years (37 to 92 years) were transplanted into 67 patients aged 70.3±12.1 years. Predissection pachymetry was statistically significantly thicker in the case of short deturgescence time (r=-0.383, P=0.001). For the same deturgescence time, predissection pachymetry was statistically significantly thicker in the Stemalpha 3 medium (691±89μm for Corneajet vs. 760±100μm for Stemalpha 3, P=0.01), with the same final pachymetry (168±31μm vs. 166±25μm, P=0.833). Graft pachymetry and total corneal pachymetry decreased significantly between the preoperative measurement and M12 (168±29μm vs. 92±57μm, P=0.0008 et 665±124μm vs. 566±73μm, P=0.027 respectively). Preoperative endothelial cell density (2938±418 cells/mm) did not correlate with postoperative visual acuity. There was a positive correlation between visual acuity at D5 and donor age (r=0.3, P=0.04). Postoperative visual acuity correlated positively with preoperative visual acuity (P<0.05). Corneal densitometry was statically higher than normal postoperative densitometry. Corneal density at M1 correlated positively with time since obtaining the donor tissue (r=0.373, P=0.043). There was no significant difference between the sub-groups of over or under 130μm. Seven patients experienced graft failure with no statistically significant graft risk factor.
The preservation medium affects predissection pachymetry with no consequence on clinical results. In our study, preoperative visual acuity and donor age were correlated with visual acuity after DSAEK.
Although donor age was associated with better visual acuity at D5, the other donor characteristics had no effect on clinical results.
我们研究的目的是评估采用Descemet膜剥离自动内皮角膜移植术（DSAEK）进行内皮角膜移植术后板层角膜移植片的进展情况，以及其特征对临床和功能结果的影响。
这是一项前瞻性研究，纳入了74例行DSAEK内皮角膜移植术的患者。角膜移植片取自法国组织库，并在含有消肿剂（Corneajet或Stemalpha 3）的保存介质中运送。在解剖前通过超声测厚法离体测量角膜移植片的厚度，然后根据需要在第一次或第二次切割后再次测量。在术前、术后第5天、第1个月、第3个月、第6个月、第9个月和第12个月，为每位患者获取logMAR矫正视力、通过眼前节光学相干断层扫描（Spectralis HRA+SDOCT，德国海德堡海德堡工程公司）测量的移植片总厚度以及角膜密度（德国韦茨拉尔Oculus公司的Pentacam）。
总体而言，将平均年龄为69.7±13.3岁（37至92岁）供体的74片角膜移植片移植到了67例平均年龄为70.3±12.1岁的患者体内。在消肿时间短的情况下，解剖前厚度在统计学上显著更厚（r=-0.383，P=0.001）。对于相同的消肿时间，在Stemalpha 3介质中解剖前厚度在统计学上显著更厚（Corneajet为691±89μm，Stemalpha 3为760±100μm，P=0.01），而最终厚度相同（分别为168±31μm和166±25μm，P=0.833）。在术前测量和术后第12个月之间，移植片厚度和角膜总厚度显著降低（分别为168±29μm对92±57μm，P=0.0008；665±124μm对566±73μm，P=0.027）。术前内皮细胞密度（2938±418个细胞/mm）与术后视力无关。术后第5天的视力与供体年龄呈正相关（r=0.3，P=0.04）。术后视力与术前视力呈正相关（P<0.05）。角膜密度测量术后统计学上高于正常密度。术后第1个月的角膜密度与获取供体组织后的时间呈正相关（r=0.373，P=0.043）。厚度超过或低于130μm的亚组之间无显著差异。7例患者发生移植失败，无统计学上显著的移植危险因素。
保存介质影响解剖前厚度，但对临床结果无影响。在我们的研究中，术前视力和供体年龄与DSAEK术后视力相关。
尽管供体年龄与术后第5天更好的视力相关，但其他供体特征对临床结果无影响。
