Pilger Daniel, Torun Necip, Maier Anna-Karina B, Schroeter Jan
Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Augentagesklinik Chausseestraße, Berlin, Germany.
BMJ Open Ophthalmol. 2020 Aug 23;5(1):e000524. doi: 10.1136/bmjophth-2020-000524. eCollection 2020.
Increasingly, cornea banks are recovering donor tissue from pseudophakic donors. Little is known about their suitability for Descemet membrane endothelial keratoplasty (DMEK) surgery in terms of endothelial cell density (ECD) and preparation failure.
We explored ECD during donor tissue preparation in 2076 grafts. Preparation failure was analysed in 1028 grafts used in DMEK surgery at our clinic. To monitor ECD and functional results, we matched 86 DMEK patients who received pseudophakic donor grafts with similar recipients of phakic donor grafts and followed them up for 36 months.
At recovery, mean ECD in pseudophakic donor grafts was 2193 cells/mm (SD 28.7) and 2364 cells/mm (SD 15.7) in phakic donor grafts (p<0.001). After cultivation, the difference increased as pseudophakic donor grafts lost 14% of ECD while phakic lost only 6% (p<0.001). At transplantation, mean ECD in pseudophakic donor grafts was 2272 cells/mm (SD 250) and 2370 cells/mm (SD 204) in phakic donor grafts (p<0.001). After transplantation, the difference in ECD increased as pseudophakic donor grafts lost 27.7% of ECD while phakic donor grafts lost only 13.3% (p<0.001). The risk of preparation failure in pseudophakic donor grafts was higher than in phakic donor grafts (OR 4.75, 95% CI 1.78 to 12.67, p=0.02). Visual acuity increased in both groups similarly.
Pseudophakic donor grafts have a lower ECD, are more prone to endothelial cell loss during recovery and surgery and are associated with a higher risk of preparation failure. Cornea banks and surgeons should consider this in the planning of graft preparation and transplantation.
越来越多的眼库从人工晶状体植入的供体获取供体组织。关于这些供体组织在内皮细胞密度（ECD）和制备失败方面是否适合Descemet膜内皮角膜移植术（DMEK）手术，人们了解甚少。
我们在2076片移植物的供体组织制备过程中探究了ECD。对我们诊所用于DMEK手术的1028片移植物的制备失败情况进行了分析。为监测ECD和功能结果，我们将86例接受人工晶状体植入供体移植物的DMEK患者与接受晶状体眼供体移植物的类似受者进行匹配，并对他们进行了36个月的随访。
获取时，人工晶状体植入供体移植物的平均ECD为2193个细胞/mm²（标准差28.7），晶状体眼供体移植物为2364个细胞/mm²（标准差15.7）（p<0.001）。培养后，差异增大，因为人工晶状体植入供体移植物的ECD损失了14%，而晶状体眼供体移植物仅损失了6%（p<0.001）。移植时,人工晶状体植入供体移植物的平均ECD为2272个细胞/mm²（标准差250），晶状体眼供体移植物为2370个细胞/mm²（标准差204）（p<0.001）。移植后，ECD差异增大，因为人工晶状体植入供体移植物的ECD损失了27.7%，而晶状体眼供体移植物仅损失了13.3%（p<0.001）。人工晶状体植入供体移植物的制备失败风险高于晶状体眼供体移植物（比值比4.75，95%置信区间1.78至12.67，p=0.02）。两组的视力均有相似程度的提高。
人工晶状体植入供体移植物的ECD较低，在获取和手术过程中更容易出现内皮细胞丢失，并且与更高的制备失败风险相关。眼库和外科医生在移植物制备和移植规划中应考虑到这一点。
