使用创新型人工前房加压装置的超薄 DSAEK：概念验证研究。

Ultra-thin DSAEK using an innovative artificial anterior chamber pressuriser: a proof-of-concept study.

机构信息

International Centre for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Via Padiglione Rama, Zelarino, 30174, Venice, Italy.

Institute of Ophthalmology, University College London, London, UK.

出版信息

Graefes Arch Clin Exp Ophthalmol. 2021 Jul;259(7):1871-1877. doi: 10.1007/s00417-021-05194-0. Epub 2021 Apr 27.

DOI:10.1007/s00417-021-05194-0

PMID:33907884

Abstract

PURPOSE

To report the impact of establishing and maintaining a high intracameral pressure (ICP) of 200 mmHg on UT-DSAEK graft preparation using an artificial anterior chamber pressuriser (ACP) control unit (Moria SA, Antony, France).

METHOD

Retrospective laboratory and clinical study. Four paired donor corneas were mounted on an artificial anterior chamber and subjected to 70 mmHg ("low") and 200 mmHg ("high") ICP using an ACP system. The central corneal thinning rate was measured after 5 min using AS-OCT and the endothelial cell viability was analysed using trypan blue and live/dead staining following 70 mmHg and 200 mmHg ICP. Visual outcomes and complications in a clinical case series of nine patients with bullous keratopathy who underwent UT-DSAEK using 200 mmHg ICP during graft preparation are reported.

RESULTS

Laboratory outcomes showed 2 ± 1% and 2 ± 2% dead cells following 70 mmHg and 200 mmHg ICP respectively. Percentage viability in the 70 mmHg group (52.94 ± 5.88%) was not found to be significantly different (p = 0.7) compared to the 200 mmHg group (59.14 ± 10.43%). The mean corneal thinning rate after applying 200 mmHg ICP was 27 ± 13 μm/min centrally (7.2%/min). In the clinical case series, two cases were combined with cataract surgery. Re-bubbling rate was 11%. At the last follow-up (259 ± 109 days), graft thickness was 83 ± 22 μm centrally, endothelial cell density was 1175 ± 566 cell/mm and the BCVA of 0.08 ± 0.12 logMAR was recorded with no episodes of rejection.

CONCLUSION

ACP control unit for UT-DSAEK graft preparation helps in consistently obtaining UT-DSAEK grafts without compromising endothelial cell viability.

摘要

目的

报告使用人工前房加压仪（ACP）控制单元（法国莫利娅 SA）将眼内压（ICP）维持在 200mmHg 对使用超声乳化角膜移植术-脱细胞角膜基质（UT-DSAEK）制备移植物的影响。

方法

回顾性实验室和临床研究。将 4 对供体角膜安装在人工前房中，使用 ACP 系统将 ICP 分别维持在 70mmHg（“低”）和 200mmHg（“高”）。使用 AS-OCT 在 5 分钟后测量中央角膜变薄率，并在 ICP 为 70mmHg 和 200mmHg 后使用台盼蓝和活/死染色分析内皮细胞活力。报告了 9 例大疱性角膜病变患者在使用人工前房加压仪（ACP）控制单元进行 UT-DSAEK 制备时，使用 200mmHg ICP 对移植物进行预处理的临床病例系列中的视力结果和并发症。

结果

实验室结果显示，分别在 70mmHg 和 200mmHg ICP 后，有 2%±1%和 2%±2%的细胞死亡。在 70mmHg 组（52.94%±5.88%）中，存活率未发现与 200mmHg 组（59.14%±10.43%）有显著差异（p=0.7）。在应用 200mmHg ICP 后，中央角膜变薄率的平均值为 27μm/min（7.2%/min）。在临床病例系列中，有 2 例合并白内障手术。再起泡率为 11%。在最后一次随访（259±109 天）时，中央移植物厚度为 83μm，内皮细胞密度为 1175±566 个细胞/mm，BCVA 为 0.08±0.12 logMAR，无排斥反应发生。