Javadi Mohammad Ali, Feizi Sepehr, Jafari Roya, Hosseini Seyed Bagher, Safapour Sharareh
Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Ophthalmic Vis Res. 2018 Jan-Mar;13(1):10-16. doi: 10.4103/jovr.jovr_213_16.
To determine the factors that influence the endothelial cell density (ECD) of donor grafts after Descemet stripping automated endothelial keratoplasty (DSAEK).
This retrospective, interventional case series comprised 77 eyes of 64 patients who underwent DSAEK. Confocal microscopy was performed at the final follow-up examination to evaluate the endothelial cell count, cell morphology, and graft thickness. Univariate and multiple linear regression analyses were used to investigate recipient-, donor-, surgical-, and postoperative related variables capable of influencing graft endothelial cell counts after DSAEK.
The mean patient age was 62.3 ± 15.6 years; patients were followed-up for 26.2 ± 20.9 months postoperatively. Forty-six eyes (59.7%) underwent stand-alone DSAEK; 31 eyes (40.3%) underwent DSAEK combined with cataract surgery. The donor trephination size was 8.0 ± 0.21 mm. The mean donor age was 30.4 ± 11.2 years, and the mean preoperative endothelial cell density was 3127.4 ± 315.1 cells/mm, which decreased to 1788.6 ± 716.5 cells/mm postoperatively ( < 0.001). The mean postoperative central graft thickness was 102.4 ± 31.6 μm. Univariate analysis revealed that postoperative ECD was significantly associated with death to preservation time ( = 0.046), graft thickness ( = 0.016), follow-up duration ( = 0.005), and graft non-attachment ( = 0.049). Multiple regression analyses identified graft thickness (β = 10.62, = 0.003) and follow-up duration (β = -22.09, = 0.001) as the significant characteristics influencing postoperative ECD.
The primary predictors of ECD after DSAEK were graft thickness and duration of follow-up. Surgeons' requests for ultrathin DSAEK donor grafts to improve visual outcomes might not have the desired postoperative outcome with respect to ECD.
确定影响深板层角膜内皮移植术（DSAEK）后供体移植物内皮细胞密度（ECD）的因素。
本回顾性、干预性病例系列研究纳入了64例行DSAEK的患者的77只眼。在末次随访检查时进行共焦显微镜检查，以评估内皮细胞计数、细胞形态和移植物厚度。采用单因素和多因素线性回归分析来研究受者、供体、手术及术后相关变量对DSAEK后移植物内皮细胞计数的影响。
患者平均年龄为62.3±15.6岁；术后随访26.2±20.9个月。46只眼（59.7%）行单纯DSAEK；31只眼（40.3%）行DSAEK联合白内障手术。供体植片直径为8.0±0.21mm。供体平均年龄为30.4±11.2岁，术前平均内皮细胞密度为3127.4±315.1个细胞/mm²，术后降至1788.6±716.5个细胞/mm²（P<0.001）。术后中央移植物平均厚度为102.4±31.6μm。单因素分析显示，术后ECD与死亡至保存时间（P = 0.046）、移植物厚度（P = 0.016）、随访时间（P = 0.005）及移植物未附着（P = 0.049）显著相关。多因素回归分析确定移植物厚度（β = 10.62，P = 0.003）和随访时间（β = -22.09，P = 0.001）是影响术后ECD的显著因素。
DSAEK后ECD的主要预测因素是移植物厚度和随访时间。外科医生为改善视觉效果而要求的超薄DSAEK供体移植物在ECD方面可能无法达到预期的术后效果。
