Hsieh Yi-Ching, Chiang Chun-Chi, Tsai Yi-Yu
Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung.
School of Medicine, China Medial University, Taichung.
Eur J Ophthalmol. 2020 Jan;30(1):155-161. doi: 10.1177/1120672119826004. Epub 2019 Jan 24.
To evaluate the thickness and shape of the posterior lamellar graft in Descemet stripping and automated endothelial keratoplasty after long-term observation.
All patients who underwent Descemet stripping and automated endothelial keratoplasty including simple and triple Descemet stripping and automated endothelial keratoplasty between August 2009 and May 2014 were enrolled in this retrospective study. To assess postoperative thickness and shape of the Descemet stripping and automated endothelial keratoplasty graft, images of the graft taken at the center (C), mid-periphery at 4 mm optical zone (P1), and periphery at 6 mm optical zone (P2) at 1, 2, and 3 years postoperatively were obtained using anterior segment optical coherence tomography.
C:P1 was 0.96, 0.96, and 0.95 at 1, 2, and 3 years postoperatively, respectively. C:P2 was 0.85, 0.84, and 0.83 at 1, 2, and 3 years postoperatively, respectively. There was a greater thinning of the central graft thickness compared with the peripheral graft thickness. The shapes of the posterior lamellar graft were variable, such as concave, asymmetrical, planar, irregular, and convex meniscus shapes. The most common shape was asymmetrical shape at 1 year postoperatively and concave at 2 and 3 years postoperatively. The most common shape of the posterior lamellar grafts was asymmetrical shape (38.18%) at 1 year postoperatively, followed by concave (34.54%), planar (20.00%), irregular (5.45%), and convex (1.81%) shapes. The most common shape was concave shape (44.44% and 57.14% for 2 and 3 years postoperatively, respectively), followed by asymmetrical (27.77% and 17.85%, respectively), planar (16.66% and 17.85%, respectively), and irregular (11.11% and 7.14%, respectively) shapes.
In our study, concave meniscus was not the only observed shape of the graft. The shape and thickness of the graft did not stabilize even 3 years postoperatively in some patients. These findings should be taken into consideration in a combination of Descemet stripping and automated endothelial keratoplasty and cataract surgery.
通过长期观察评估后弹力层剥除自动内皮角膜移植术中后弹力层植片的厚度和形态。
本回顾性研究纳入了2009年8月至2014年5月期间接受后弹力层剥除自动内皮角膜移植术（包括单纯和三联后弹力层剥除自动内皮角膜移植术）的所有患者。为评估后弹力层剥除自动内皮角膜移植术植片术后的厚度和形态，使用眼前节光学相干断层扫描获取术后1年、2年和3年时植片中心（C）、4mm光学区中周边（P1）和6mm光学区周边（P2）的图像。
术后1年、2年和3年时C:P1分别为0.96、0.96和0.95。术后1年、2年和3年时C:P2分别为0.85、0.84和0.83。与周边植片厚度相比，中央植片厚度变薄更明显。后弹力层植片的形态各异，如凹形、不对称形、平面形、不规则形和凸形半月板形。最常见的形态是术后1年为不对称形，术后2年和3年为凹形。后弹力层植片最常见的形态在术后1年是不对称形（38.18%），其次是凹形（34.54%）、平面形（20.00%）、不规则形（5.45%）和凸形（1.81%）。最常见的形态在术后2年和3年分别是凹形（分别为44.44%和57.14%），其次是不对称形（分别为27.77%和17.85%）、平面形（分别为16.66%和17.85%）和不规则形（分别为11.11%和7.14%）。
在我们的研究中，凹形半月板并非观察到的唯一植片形态。甚至在术后3年，部分患者植片的形态和厚度仍未稳定。在后弹力层剥除自动内皮角膜移植术与白内障手术联合应用时应考虑这些发现。
