Fajgenbaum Mark A P, Hollick Emma J
Ophthalmology Department, King's College Hospital, London, United Kingdom.
Cornea. 2018 Dec;37(12):1484-1489. doi: 10.1097/ICO.0000000000001762.
High intraocular pressure (IOP) is common in association with intracameral air and gas tamponade after Descemet membrane endothelial keratoplasty (DMEK); yet its influence on endothelial cell survival is unknown. Our aim was to determine the effect of high IOP measured 2 hours after DMEK on 1-month endothelial cell density (ECD). The influence of other potentially relevant factors was also investigated.
Retrospective, consecutive series. Inclusions: low-to-moderate risk DMEK surgery alone or combined with phacoemulsification.
previous penetrating keratoplasty or glaucoma surgery; grafts with any of the following in the first month: rebubble, rejection, or graft failure.
Sixty-two grafts met inclusion with 60 having IOP recorded at 2 hours. Thirty-eight percent (23/60) had IOP >30 mm Hg and 22% (13/60) had IOP >40 mm Hg at 2 hours. All grafts with IOP >30 mm Hg had air released and immediate normalization of pressure. One-month ECD (mean ± standard error of mean) was 1872 ± 58 cells/mm, representing cell loss of 29.8 ± 2.0%. Two-hour IOP was highly insignificant against 1-month ECD when tested as a continuous variable (P = 0.78). Lower 1-month ECD was statistically correlated with lower donor count (P = 0.002) and combined DMEK-phaco surgery (P = 0.01) on univariate and multivariate analysis. Insignificant factors (P > 0.05) against 1-month ECD included patient age, sex and race, surgical indication (Fuchs endothelial dystrophy vs. non-Fuchs endothelial dystrophy), and donor age.
Increased IOP at 2 hours is common after DMEK, but does not seem to influence early endothelial cell survival. One-month ECD was influenced by donor counts and combined cataract surgery.
在Descemet膜内皮角膜移植术（DMEK）后，高眼压（IOP）与前房内空气和气体填塞相关，但它对内皮细胞存活的影响尚不清楚。我们的目的是确定DMEK术后2小时测得的高眼压对1个月时内皮细胞密度（ECD）的影响。还研究了其他潜在相关因素的影响。
回顾性连续系列研究。纳入标准：单纯低至中度风险的DMEK手术或联合超声乳化白内障吸除术。
既往穿透性角膜移植术或青光眼手术；术后第一个月出现以下任何一种情况的移植物：再次形成气泡、排斥反应或移植失败。
62例移植物符合纳入标准，其中60例在术后2小时记录了眼压。38%（23/60）的患者在术后2小时眼压>30 mmHg，22%（13/60）的患者眼压>40 mmHg。所有眼压>30 mmHg的移植物均进行了放气，眼压立即恢复正常。1个月时的ECD（平均值±平均标准误差）为1872±58个细胞/mm²，细胞损失率为29.8±2.0%。当将术后2小时眼压作为连续变量进行测试时，其与1个月时的ECD高度无关（P = 0.78）。在单因素和多因素分析中，1个月时较低的ECD与较低的供体细胞数量（P = 0.002）和DMEK联合超声乳化白内障吸除术（P = 0.01）具有统计学相关性。与1个月时的ECD无关的因素（P>0.05）包括患者年龄、性别和种族、手术指征（Fuchs内皮营养不良与非Fuchs内皮营养不良）以及供体年龄。
DMEK术后2小时眼压升高很常见，但似乎并不影响早期内皮细胞存活。1个月时的ECD受供体细胞数量和联合白内障手术的影响。
