Wakimasu Koichi, Kitazawa Koji, Kayukawa Kanae, Yokota Isao, Inatomi Tsutomu, Hieda Osamu, Sotozono Chie, Kinoshita Shigeru
Ophthalmology, Baptist Eye Institute, Kyoto, Japan.
Ophthalmology, Kyoto prefectural univeristy of medicine, Kyoto, Japan.
BMJ Open Ophthalmol. 2020 Jan 29;5(1):e000354. doi: 10.1136/bmjophth-2019-000354. eCollection 2020.
To assess graft survival and endothelial cell density (ECD) over a 5-year follow-up period after Descemet's stripping automated endothelial keratoplasty (DSAEK).
This retrospective study involved 130 eyes of 130 consecutive patients with Fuchs endothelial corneal dystrophy (FECD), non-FECD bullous keratopathy (BK) (non-FECD) or BK post-trabeculectomy or tube-shunt surgery (glaucoma with bleb) who underwent DSAEK between August 2007 and January 2012 and were followed for more than 5 years postoperatively. Patients with previous keratoplasty, graft suture failure, primary graft failure, postoperative endophthalmitis and ocular infection were excluded. Graft survival and ECD was then examined in all patients who underwent DSAEK and completed the postoperative follow-up period. The association between clinical factors and 5-year graft survival after DSAEK was analysed with multivariate logistic regression analysis.
The overall graft survival rate at 5 years postoperatively was 85%, yet significantly poorer in the glaucoma with bleb eyes (47%) than in the FECD (100%) or non-FECD (90%) eyes (p<0.01, log-rank test). In the FECD, non-FECD and glaucoma with bleb eyes, the mean ECD at 5 years postoperatively was 1054 cells/mm, 1137 cells/mm and 756 cells/mm, respectively. Multivariate logistic regression analysis showed history of trabeculectomy or tube-shunt surgery and postoperative allograft rejection to be negative factors for graft survival at 5 years after DSAEK (OR 0.01, 95% CI 0.00 to 0.10 and OR 0.02, 95% CI 0.00 to 0.33, respectively).
Our findings show that at 5 years postoperatively, the surgical outcome after DSAEK was poorer in eyes after trabeculectomy or tube-shunt surgery.
UMIN000024891.
评估深板层角膜内皮移植术（DSAEK）后5年随访期内的移植物存活率和内皮细胞密度（ECD）。
这项回顾性研究纳入了2007年8月至2012年1月期间连续130例接受DSAEK治疗且术后随访超过5年的患者的130只眼，这些患者患有富克斯角膜内皮营养不良（FECD）、非FECD大疱性角膜病变（BK）（非FECD）或小梁切除术后或引流管分流手术后的BK（伴有滤过泡的青光眼）。排除既往有角膜移植术、移植物缝线失败、原发性移植物失败、术后眼内炎和眼部感染的患者。然后对所有接受DSAEK并完成术后随访期的患者进行移植物存活率和ECD检查。采用多因素逻辑回归分析DSAEK术后临床因素与5年移植物存活率之间的关联。
术后5年的总体移植物存活率为85%，然而伴有滤过泡的青光眼患者的移植物存活率（47%）明显低于FECD患者（100%）或非FECD患者（90%）（p<0.01，对数秩检验）。在FECD、非FECD和伴有滤过泡的青光眼患者中，术后5年的平均ECD分别为1054个细胞/mm²、1137个细胞/mm²和756个细胞/mm²。多因素逻辑回归分析显示，小梁切除术或引流管分流手术史以及术后同种异体移植物排斥反应是DSAEK术后5年移植物存活的负性因素（OR分别为0.01，95%CI为0.00至0.10；OR为0.02，95%CI为0.00至0.33）。
我们的研究结果表明，术后5年时，小梁切除术或引流管分流手术后的眼睛接受DSAEK的手术效果较差。
UMIN000024891。
