有晶状体眼的后弹力层剥除自动内皮角膜移植术：切口改良以减少白内障形成。

Descemet stripping automated endothelial keratoplasty in phakic eyes: incision modification reducing cataract formation.

作者信息

Beltz Jacqueline, Madi Silvana, Nahum Yoav, Santorum Paolo, Busin Massimo

机构信息

Department of Ophthalmology, Villa Igea Private Hospital, Forlì 47122, Italy.

Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì 47122, Italy.

出版信息

Int J Ophthalmol. 2018 Jan 18;11(1):53-57. doi: 10.18240/ijo.2018.01.10. eCollection 2018.

DOI:10.18240/ijo.2018.01.10

PMID:29375991

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5767658/

Abstract

AIM

To evaluate the efficacy of a technical modification to reduce the incidence of traumatic cataract induced by Descemet stripping automated endothelial keratoplasty (DSAEK) performed in phakic eyes.

METHODS

A retrospective cohort study. The records of all patients with a clear crystalline lens and endothelial failure that underwent modified DSAEK at our insitution were reviewed. In this modification, in order to avoid inadvertent touch of the insertion forceps against the exposed crystalline lens while passing across the anterior chamber, the incision sites were shifted from the standard 9 and 3 o'clock positions, superiorly to the 10 and 2 o'clock position respectively. Formation of typically traumatic, anterior subcapsular cataract in these patients was compared to that observed in a cohort including all the patients with a clear crystalline lens and endothelial failure that underwent conventional DSAEK at our institution.

RESULTS

The study group included 49 eyes following modified DSAEK and the control group included 35 eyes following DSAEK with conventional incision sites. Anterior subcapsular cataract occurring 4mo or less postoperatively was identified in 2 of 49 (4%) eyes in the study group and 7 of 35 (20%) eyes in the control group. The rates of traumatic cataract were significantly higher in the control group in comparison to the study group (=0.03, RR=4.9, 95%CI 1.08-22.1).

CONCLUSION

Traumatic cataract formation following phakic DSAEK may be avoided with a simple modification to the position of the incision sites.

摘要

目的

评估一项技术改良措施在降低有晶状体眼行Descemet膜剥除自动内皮角膜移植术（DSAEK）所致外伤性白内障发生率方面的疗效。

方法

一项回顾性队列研究。回顾了在我们机构接受改良DSAEK的所有晶状体透明且存在内皮功能衰竭患者的记录。在这项改良措施中，为避免插入镊在穿过前房时意外触碰暴露的晶状体，切口位置从标准的9点和3点位置分别向上移至10点和2点位置。将这些患者中典型外伤性前囊下白内障的形成情况与在我们机构接受传统DSAEK的所有晶状体透明且存在内皮功能衰竭患者组成的队列中观察到的情况进行比较。

结果

研究组包括49只接受改良DSAEK后的眼睛，对照组包括35只接受传统切口位置DSAEK后的眼睛。研究组49只眼中有2只（4%）在术后4个月内发生了前囊下白内障，对照组35只眼中有7只（20%）发生了前囊下白内障。与研究组相比，对照组外伤性白内障的发生率显著更高（=0.03，RR=4.9，95%CI 1.08 - 22.1）。