Madi Silvana, Leon Pia, Nahum Yoav, DʼAngelo Sergio, Giannaccare Giuseppe, Beltz Jacqueline, Busin Massimo
Department of Ophthalmology, Ospedali Privati Forlì, Forlì, Italy.
Istituto Internazionale per Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy.
Cornea. 2019 Sep;38(9):1192-1197. doi: 10.1097/ICO.0000000000001999.
To report 5-year outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) with a central graft thickness intended to be <100 μm.
This retrospective, consecutive, interventional case series included 354 eyes with endothelial decompensation due to various causes (Fuchs endothelial dystrophy, pseudophakic or aphakic bullous keratopathy, failed previous graft, herpetic endothelitis, or buphthalmos). Donor tissue was prepared using the microkeratome-assisted double-pass technique aiming at a graft thickness <100 μm. The Descemet membrane was stripped under air. The graft was delivered into the anterior chamber using the pull-through technique through a 3.2-mm clear corneal incision using a modified Busin glide. The best spectacle-corrected visual acuity (BSCVA), endothelial cell loss, graft survival rates, and immunologic rejection rates were evaluated.
Follow-up data at 1, 2, 3, and 5 years after UT-DSAEK were collected from 214, 172, 147, and 105 eyes, respectively. After excluding eyes with comorbidities, BSCVA better than or equal to 20/20 was recorded in 36.3%, 37.4%, 46.4%, and 53.4% of eyes, respectively, whereas BSCVA better than or equal to 20/40 was documented in 95.5%, 95.3%, 96.0%, and 96.6% of eyes, respectively. The mean endothelial cell loss was 35.4%, 42.3%, 43.3%, and 52.3%; Kaplan-Meier graft survival probability was 99.1%, 96.2%, 94.2%, and 94.2%, and Kaplan-Meier cumulative probability of a rejection episode was 3.4%, 4.3%, 5%, and 6.9% at 1, 2, 3, and 5 years, respectively.
UT-DSAEK grafts allow excellent 5-year outcomes, including BSCVA, endothelial cell density, and survival rates comparable with those recorded post-Descemet membrane endothelial keratoplasty, but with a higher immunologic rejection rate.
报告超薄Descemet膜剥离自动内皮角膜移植术（UT-DSAEK）5年的手术效果，该手术中中央移植片的厚度设定为小于100μm。
这是一项回顾性、连续性、干预性病例系列研究，纳入了354例因各种原因导致内皮失代偿的患眼（Fuchs内皮营养不良、人工晶状体眼或无晶状体眼大泡性角膜病变、既往移植失败、疱疹性内皮炎或牛眼）。使用微型角膜刀辅助双程技术制备供体组织，目标是移植片厚度小于100μm。在空气下剥离Descemet膜。通过改良的Busin滑行器，经3.2mm透明角膜切口，采用牵拉技术将移植片送入前房。评估最佳矫正视力（BSCVA）、内皮细胞丢失、移植片存活率和免疫排斥率。
分别收集了UT-DSAEK术后1年、2年、3年和5年的随访数据，涉及214只眼、172只眼、147只眼和105只眼。排除合并其他疾病的患眼后，BSCVA优于或等于20/20的患眼比例分别为36.3%、37.4%、46.4%和53.4%，而BSCVA优于或等于20/40的患眼比例分别为95.5%、95.3%、96.0%和96.6%。内皮细胞平均丢失率分别为35.4%、42.3%、43.3%和52.3%；Kaplan-Meier法计算的移植片存活概率分别为99.1%、96.2%、94.2%和94.2%，1年、2年、3年和5年发生排斥反应的Kaplan-Meier累积概率分别为3.4%、4.3%、5%和6.9%。
UT-DSAEK移植片具有出色的5年手术效果，包括BSCVA、内皮细胞密度和存活率与Descemet膜内皮角膜移植术后的记录相当，但免疫排斥率较高。
