Nahum Yoav, Leon Pia, Mimouni Michael, Busin Massimo
*Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel; †Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; ‡Department of Ophthalmology, "Villa Igea" Hospital, Forlì, Italy; §Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy; and ¶Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.
Cornea. 2017 Mar;36(3):265-268. doi: 10.1097/ICO.0000000000001123.
To identify risk factors associated with postoperative graft detachment after Descemet stripping automated endothelial keratoplasty (DSAEK).
In this retrospective institutional cohort study, the study group included all consecutive eyes that underwent primary DSAEK between January 2005 and October 2015 at Villa Serena-Villa Igea private hospitals (Forlì, Italy) and developed postoperative graft detachment (n = 45). The control group included all eyes that underwent primary DSAEK during the same period and did not develop graft detachment (n = 1167). The main outcome measure was whether or not postoperative graft detachment occurred.
Main indications for surgery included Fuchs endothelial dystrophy (525/1212 = 41%), pseudophakic bullous keratopathy (422/1212 = 35%), and a failed penetrating keratoplasty (PK) graft (190/1212 = 16%). Postoperative graft detachment occurred in 45 of 1212 (3.7%) eyes. Medically treated glaucoma, previous trabeculectomy, previous aqueous shunt procedure, and failed PK were all associated with an increased risk for graft detachment in univariate analysis. No particular lens status at the time of graft implantation was significantly associated with graft detachment, including the presence of an anterior chamber intraocular lens [odds ratio (OR), 1.5; 95% confidence interval (CI), 0.35-6.46, P = 0.58] or aphakia at the time of graft transplantation (OR, 1.37; 95% CI, 0.41-4.57, P = 0.74). Cataract removal during surgery was not associated with an increased risk for detachment (OR, 0.77; 95% CI, 0.39-1.5, P = 0.47). Previous trabeculectomy (OR, 4.21; 95% CI, 1.53-11.56, P = 0.005) and a previous failed PK graft (OR, 3.04; 95% CI, 1.6-5.78, P = 0.001) were the only independent risk factors for graft detachment in multivariate analyses.
Previous PK and trabeculectomy are independent risk factors for postoperative graft detachment in primary DSAEK.
确定与Descemet膜剥离自动内皮角膜移植术（DSAEK）术后植片脱离相关的危险因素。
在这项回顾性机构队列研究中，研究组包括2005年1月至2015年10月期间在意大利弗利的维拉·塞雷纳 - 维拉·伊盖亚私立医院接受初次DSAEK并发生术后植片脱离的所有连续病例（n = 45）。对照组包括同期接受初次DSAEK且未发生植片脱离的所有病例（n = 1167）。主要观察指标是术后是否发生植片脱离。
手术的主要适应证包括Fuchs内皮营养不良（525/1212 = 41%）、人工晶状体眼大泡性角膜病变（422/1212 = 35%）和穿透性角膜移植术（PK）植片失败（190/1212 = 16%）。1212只眼中有45只（3.7%）发生术后植片脱离。在单因素分析中，药物治疗的青光眼、既往小梁切除术、既往房水引流手术和PK失败均与植片脱离风险增加相关。植片植入时的特定晶状体状态与植片脱离无显著相关性，包括前房人工晶状体的存在[比值比（OR），1.5；95%置信区间（CI），0.35 - 6.46，P = 0.58]或植片移植时的无晶状体状态（OR，1.37；95% CI，0.41 - 4.57，P = 0.74）。手术中白内障摘除与脱离风险增加无关（OR，0.77；95% CI，0.39 - 1.5，P = 0.47）。在多因素分析中，既往小梁切除术（OR，4.21；95% CI，1.53 - 11.56，P = 0.005）和既往PK植片失败（OR，3.04；95% CI，1.6 - 5.78，P = 0.001）是植片脱离的唯一独立危险因素。
既往PK和小梁切除术是初次DSAEK术后植片脱离的独立危险因素。
