Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Indian J Ophthalmol. 2019 Oct;67(10):1586-1592. doi: 10.4103/ijo.IJO_1729_18.
To evaluate the clinical factors associated with repeat Descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty (PKP) in cases of failed DSAEK.
Retrospective observational study of cases with failed DSAEK admitted to our center for a repeat keratoplasty over 5 years (January 2013-Decemeber 2017) was undertaken. Demographic and perioperative details of all cases and type of repeat keratoplasty were recorded. Logistic regression analysis was performed to analyze the factors affecting the type of repeat keratoplasty.
total of 94 eyes with failed DSAEK were evaluated. Repeat DSAEK was performed in 66% and PKP in 34% of cases. Significantly increased odds for requiring PKP were observed in association with stromal scarring [odds ratio (OR) = 2.9, P = 0.018)], trainee surgeons (OR = 4.05, P = 0.008), intraoperative complications (OR = 4.58, P = 0.003), scleral fixated intraocular lens or anterior chamber intraocular lens in situ (OR = 33.8, P < 0.001), secondary glaucoma (OR = 3.02, P = 0.015), peripheral anterior synechiae (OR = 8.6, P < 0.001), preoperative corneal thickness (OR = 1.01, P < 0001), time to primary surgery (OR = 1.03, P = 0.03), post-DSAEK host thickness (OR = 1.01, P < 0.001), and time interval from graft failure to regraft (OR = 1.18, P < 0.001). All eyes with congenital hereditary endothelial dystrophy, bee-sting-induced corneal decompensation, Axenfeld-Rieger syndrome, and multiple failed grafts underwent secondary PKP. All cases (nine eyes) that required surgical intervention for secondary glaucoma underwent secondary PKP (P < 0.001).
Repeat DSAEK is feasible in up to two-third of cases of failed DSAEK. A PKP is required in one-third of cases, and various preoperative, intraoperative and postoperative factors are associated with unsuitability for repeat DSAEK.
评估导致初次 Descemet 撕囊自动化内皮角膜移植术（DSAEK）失败后需要再次行 DSAEK 或穿透性角膜移植术（PKP）的临床相关因素。
回顾性观察性研究纳入 2013 年 1 月至 2017 年 12 月间因初次 DSAEK 失败而在我院行再次角膜移植的病例。记录所有病例的人口统计学和围手术期细节以及再次行角膜移植的类型。采用逻辑回归分析评估影响再次行角膜移植类型的因素。
共评估了 94 只初次 DSAEK 失败的患眼。66%的病例行再次 DSAEK，34%的病例行 PKP。术中并发症（OR = 4.58，P = 0.003）、术中使用巩膜固定眼内透镜或房内眼内透镜（OR = 33.8，P < 0.001）、继发性青光眼（OR = 3.02，P = 0.015）、周边前粘连（OR = 8.6，P < 0.001）、术前角膜厚度（OR = 1.01，P < 0001）、初次手术时间（OR = 1.03，P = 0.03）、DSAEK 后供体厚度（OR = 1.01，P < 0.001）、移植物失败至再次移植的时间间隔（OR = 1.18，P < 0.001）与需要行 PKP 显著相关。所有患有先天性遗传性内皮营养不良、蜂蜇伤引起的角膜失代偿、Axenfeld-Rieger 综合征和多次移植失败的患者均行二次 PKP。所有因继发性青光眼而需要手术干预的患者（9 只眼）均行二次 PKP（P < 0.001）。
初次 DSAEK 失败后，高达三分之二的病例可行再次 DSAEK。三分之一的病例需要行 PKP，术前、术中及术后的多种因素与再次 DSAEK 不适用相关。
