Department of Ophthalmology, Peking University Third Hospital, Beijing, China.
Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China.
Eye (Lond). 2018 Apr;32(4):679-686. doi: 10.1038/eye.2017.282. Epub 2017 Dec 15.
PurposeTo evaluate the clinical outcome of Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with iridocorneal endothelial (ICE) syndrome.Patients and methodsA retrospective case series study was conducted. Eighteen consecutive Chinese patients with 20 DSAEK grafts were enrolled. Participants were evaluated by anterior segment optical coherence tomography and confocal microscopy. Postoperative complications, graft survival, endothelial cell counts, corneal thickness, and anterior chamber depth were analysed. A Log-rank test in a Kaplan-Meier analysis and a Cox proportional hazard regression were used to analyse potential risk factors of graft failure.ResultsThe mean follow-up duration was 19.0±8.6 months. The donors' endothelial cell density (ECD) (cells/mm) values at 1, 3, 6, 12, 18, and 24 months were 3342.2±287.0, 1897.6±745.4, 1793.6±755.7, 1618.1±604.3, 1421.9±650.8, 1265.1±844.1, and 1148.2±1217.8, respectively. Eleven of the 20 grafts exhibited secondary graft failure, with a mean estimated graft survival of 23.4 months. Immediate postoperative complications (air bubble ventilation for elevated intraocular pressure or rebubbling for graft detachment) were more common in eyes exhibiting graft failure (P=0.040). Postkeratoplasty glaucoma surgery emerged as a risk factor of graft failure, with a hazard ratio of 5.174. Eyes with a poor prognosis showed statistically greater central corneal thickness at 1 month, greater graft thickness at 3 months, and a shallower anterior chamber at 6 and 12 months.ConclusionsThe long-term outcome of DSAEK in eyes with ICE syndrome is relatively poor. Immediate postoperative complications, postkeratoplasty glaucoma surgery, thicker corneal parameters, and a shallow anterior chamber were all associated with graft failure.
评估撕囊自动化角膜内皮移植术（DSAEK）治疗虹膜角膜内皮（ICE）综合征患者的临床疗效。
本研究为回顾性病例系列研究。纳入了 18 例（20 只眼）接受 DSAEK 移植术的中国 ICE 综合征患者。使用眼前节光学相干断层扫描和共聚焦显微镜对患者进行评估。分析术后并发症、移植物存活率、内皮细胞计数、角膜厚度和前房深度。Kaplan-Meier 分析中的对数秩检验和 Cox 比例风险回归用于分析移植物失败的潜在危险因素。
平均随访时间为 19.0±8.6 个月。供体术后 1、3、6、12、18 和 24 个月时的内皮细胞密度（ECD）值分别为 3342.2±287.0、1897.6±745.4、1793.6±755.7、1618.1±604.3、1421.9±650.8、1265.1±844.1 和 1148.2±1217.8。20 只移植眼中有 11 只发生继发性移植物失败，估计移植物存活率平均为 23.4 个月。与移植物存活组相比，发生移植物失败的患者术后即刻并发症（眼压升高时行空气泡填充或移植片脱离时行再次注气）更常见（P=0.040）。青光眼术后行角膜移植术是移植物失败的危险因素，风险比为 5.174。预后不良的患者术后 1 个月时中央角膜厚度更大，术后 3 个月时移植片厚度更大，术后 6 个月和 12 个月时前房深度更浅。
ICE 综合征患者行 DSAEK 的长期疗效相对较差。术后即刻并发症、青光眼术后行角膜移植术、角膜参数较厚和前房较浅均与移植物失败有关。
