Neiter E, Goetz C, Tortuyaux F, Ehrhardt A, Houmad N, Perone J-M
Département d'ophtalmologie, hôpital de Mercy, CHR de Metz-Thionville, 1, allée du Château, CS45001, 57085 Metz cedex 03, France.
Plateforme d'appui à la recherche clinique (PARC), hôpital de Mercy, CHR de Metz-Thionville, 1, allée du Château, CS45001, 57085 Metz cedex 03, France.
J Fr Ophtalmol. 2017 Dec;40(10):844-852. doi: 10.1016/j.jfo.2017.05.011. Epub 2017 Nov 11.
To report our anatomical and functional results as well as possible complications of the first six Descemet's stripping endothelial keratoplasties (DSAEK) performed in our department for endothelial decompensation after penetrating keratoplasty (PK) METHODS: This was a retrospective and observational monocentric study of six patients with DSAEK after prior PK between January 2015 and July 2016. The data collected were: demographic characteristics (age, sex), ophthalmological comorbidities, initial indication for PK, delay between PK and DSAEK. Best corrected visual acuity (BCVA) preoperatively and at 1, 3 and 6 months postoperatively were collected in Monoyer's and Parinaud scale and converted to log MAR for statistical analysis. The central cornea and graft thickness measured on OCT as well as postoperative complications were also collected.
Mean follow-up duration was 7.2 months [3-10]. The average time after PK was 7.7 years. The mean age of the patients was 67.5 years [32-87]. The initial indication for PK was Fuchs dystrophy (3/6), pseudophakic bullous keratopathy (1/6), corneal laceration (1/6) and other corneal dystrophy (1/6). The authors report one case a combined phaco-DSAEK surgery. The complications observed were: an early graft detachment treated by an additional air bubble injection (1/6) and cystoid macular edema in one other case. The average central corneal thickness decreased from 780μm at day 7 postoperatively to 656μm at 6 months. The average thickness of the graft decreased from 154μm at day 7 to 122μm at 6 months. The mean preoperative BCVA was 1.52 log MAR [1.0-1.7], compared to the mean postoperative BCVA which was 1.5 log MAR [1.1-2.3] at 1 month, 1.15 log MAR [0.5-1.7] at 3 months and 1.1 log MAR [0.7-1.7] at 6 months (data available for 4 patients at 6 months). The recovery of visual acuity was limited in 2 cases, despite corneal clarity restored in all our patients.
Our results can be compared to those described in literature. As more penetrating keratoplasty grafts reach the end of their lives, this will allow for more powerful studies.
DSAEK on eyes previously treated with PK is a good alternative to a new PK in the case of endothelial decompensation of the graft. The possibility of a posterior lamellar graft allows for faster visual recovery, with preservation of the anterior corneal power and a lower rate of complications.
报告我们科室开展的前六例穿透性角膜移植术（PK）后内皮失代偿行Descemet膜剥脱性内皮角膜移植术（DSAEK）的解剖学和功能结果以及可能出现的并发症。方法：这是一项对2015年1月至2016年7月期间6例穿透性角膜移植术后行DSAEK患者的回顾性单中心观察研究。收集的数据包括：人口统计学特征（年龄、性别）、眼科合并症、PK的初始指征、PK与DSAEK之间的间隔时间。术前及术后1个月、3个月和6个月的最佳矫正视力（BCVA）采用Monoyer和帕利诺量表进行收集，并转换为log MAR用于统计分析。还收集了OCT测量的中央角膜和植片厚度以及术后并发症。结果：平均随访时间为7.2个月[3 - 10个月]。PK后的平均时间为7.7年。患者的平均年龄为67.5岁[32 - 87岁]。PK的初始指征为富克斯营养不良（3/6）、人工晶状体眼大泡性角膜病变（1/6）、角膜裂伤（1/6）和其他角膜营养不良（1/6）。作者报告了1例联合超声乳化 - DSAEK手术病例。观察到的并发症有：1例早期植片脱离，通过额外注射气泡进行治疗（1/6），另一例出现黄斑囊样水肿。术后第7天中央角膜平均厚度从780μm降至术后6个月的656μm。植片平均厚度从第7天的154μm降至6个月时的122μm。术前BCVA平均为1.52 log MAR[1.0 - 1.7]，术后1个月BCVA平均为1.5 log MAR[1.1 - 2.3]，3个月时为1.15 log MAR[0.5 - 1.7]，6个月时为1.1 log MAR[0.7 - 1.7]（6个月时4例患者数据可用）。尽管所有患者角膜均恢复透明，但2例患者视力恢复有限。讨论：我们的结果可与文献中描述的结果进行比较。随着越来越多的穿透性角膜移植植片进入使用寿命末期，这将允许进行更有力的研究。结论：对于移植片内皮失代偿的情况，在先前接受过PK的眼中行DSAEK是新的PK的良好替代方案。后板层移植的可能性使视力恢复更快，保留了前角膜屈光力且并发症发生率较低。
