Rotterdam Eye Hospital, Rotterdam, The Netherlands.
PLoS One. 2018 Oct 5;13(10):e0203993. doi: 10.1371/journal.pone.0203993. eCollection 2018.
Comparison of conventional Penetrating Keratoplasty (PKP), posterior mushroom PKP and Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) regarding overall graft survival of primary corneal transplants for Fuchs´ endothelial dystrophy (FED), best spectacle-corrected visual acuity (BSCVA) and astigmatism.
Single centre study using prospectively collected data from the national database for follow-up of corneal transplants. Main outcome parameters: 10 years graft survival, astigmatism at 24 months, pre- and post-operative BSCVA.
In total, 721 cases were included: PKP, n = 171; posterior mushroom PKP, n = 91; and DSAEK, n = 459. There was no significant difference in graft survival between PKP, posterior mushroom PKP and the DSAEK technique (log-rank test, P = 0.12). The overall post-operative BSCVA improvement in all treatment groups was significant (paired t-test, P<0.001). Pre-operative BSCVA was better for the DSAEK group (0.68 ± 0.41 logMAR) as compared to the PKP (0.89 ± 0.53) and posterior mushroom PKP group (0.90 ± 0.58); ANOVA, P<0.001. After 24 months, BSCVA was significantly better for the DSAEK group (0.25 ± 0.26 logMAR) compared to the PKP (0.35 ± 0.29) and posterior mushroom PKP group (0.41 ± 0.42); ANOVA, P<0.001. A significant difference in astigmatism was found (median test, P<0.001) between the DSAEK (1.7 ± 1.1 D), PKP (4.6 ± 2.7 D) and posterior mushroom PKP group (4.5 ± 3.3 D). The significantly lower DSAEK-induced astigmatism was confirmed by vector analysis.
There was no difference in graft survival and BSCVA improvement between conventional PKP, inverted mushroom PKP and DSAEK in this study. The significantly lower changes in astigmatism, wound stability and faster visual rehabilitation with DSAEK surgery are favourable aspects of this technique. The benefits of posterior lamellar keratoplasty warrant earlier intervention, which may contribute to preserve better vision for a prolonged period of remaining lifetime.
比较传统穿透性角膜移植术（PKP）、后蘑菇形 PKP 和撕囊的自动化内皮角膜移植术（DSAEK）在原发性角膜移植治疗 Fuchs 角膜内皮营养不良（FED）中的总体移植物存活率、最佳矫正视力（BSCVA）和散光方面的差异。
使用全国角膜移植随访数据库中前瞻性收集的数据进行单中心研究。主要观察指标：10 年移植物存活率、术后 24 个月时的散光、术前和术后 BSCVA。
共纳入 721 例患者：PKP 组 171 例，后蘑菇形 PKP 组 91 例，DSAEK 组 459 例。PKP、后蘑菇形 PKP 和 DSAEK 技术之间的移植物存活率无显著差异（对数秩检验，P=0.12）。所有治疗组的术后总体 BSCVA 改善均有统计学意义（配对 t 检验，P<0.001）。与 PKP 组（0.89±0.53）和后蘑菇形 PKP 组（0.90±0.58）相比，DSAEK 组的术前 BSCVA 更好（0.68±0.41 logMAR）；方差分析，P<0.001。术后 24 个月时，DSAEK 组的 BSCVA（0.25±0.26 logMAR）明显优于 PKP 组（0.35±0.29）和后蘑菇形 PKP 组（0.41±0.42）；方差分析，P<0.001。DSAEK 组（1.7±1.1 D）、PKP 组（4.6±2.7 D）和后蘑菇形 PKP 组（4.5±3.3 D）之间的散光存在显著差异（中位数检验，P<0.001）。通过向量分析证实，DSAEK 引起的散光明显较低。
在本研究中，传统 PKP、倒置蘑菇形 PKP 和 DSAEK 之间在移植物存活率和 BSCVA 改善方面无差异。DSAEK 手术引起的散光变化较小、伤口稳定性好、视力恢复更快，是该技术的有利方面。后板层角膜移植术的益处需要更早的干预，这可能有助于延长剩余寿命期间保持更好的视力。
