术后 6 个月内皮细胞密度对深板层角膜内皮移植术后移植物存活的影响。
Effect of Six-Month Postoperative Endothelial Cell Density on Graft Survival after Descemet Membrane Endothelial Keratoplasty.
机构信息
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands.
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; University Eye Hospital, Munster, Germany; ELZA Institute Dietikon/Zurich, Switzerland.
出版信息
Ophthalmology. 2021 Dec;128(12):1689-1698. doi: 10.1016/j.ophtha.2021.05.022. Epub 2021 May 23.
PURPOSE
To analyze if 6-month endothelial cell density (ECD) affects long-term ECD outcome and graft survival 5 years after Descemet membrane endothelial keratoplasty (DMEK) in eyes with Fuchs endothelial corneal dystrophy (FECD).
DESIGN
Retrospective cohort study.
PARTICIPANTS
A total of 585 DMEK eyes were included. The study group was divided into 4 groups based on 6-month ECD quartiles: group 1 (n = 146) with 313 to 1245 cells/mm, group 2 (n = 148) with 1246 to 1610 cells/mm, group 3 (n = 145) with 1611 to 1938 cells/mm, and group 4 (n = 146) with 1939 to 2760 cells/mm. Group 1 was further split into subgroups 1a (n = 36) with 6-month ECD of ≤828 cells/mm, 1b (n = 37) with 829 to 1023 cells/mm, 1c (n = 37) with 1024 to 1140 cells/mm, and 1d (n = 36) 1141 to 1245 cells/mm.
METHODS
Descemet membrane endothelial keratoplasty.
MAIN OUTCOME MEASURES
Long-term ECD, graft survival, and postoperative complication rates.
RESULTS
For group 1, 6-month ECD decreased from 951 (±233) cells/mm (n = 146) to 735 (±216) cells/mm (n = 99) at 5 years postoperatively. Group 1 graft survival probability was 0.95 (95% confidence interval [CI], 0.91-0.99] at 5 years postoperatively, which was lower than for groups 2 to 4 (P = 0.001). Five-year graft survival in subgroup 1a was 0.79 (95% CI, 0.67-0.94), which was lower than in subgroups 1b to 1d (P = 0.001). Preoperative ECD did not influence graft survival (P = 0.400), and higher 6-month ECD values were associated with lower graft failure rates (hazard ratio, 0.994; 95% CI, 0.99-1.00; P = 0.001).
CONCLUSIONS
Six-month ECD is associated with DMEK graft survival. High early cell loss after DMEK negatively affects long-term ECD outcome and graft survival. Grafts in the lowest 6-month ECD subgroup (≤828 cells/mm) are at higher risk of failure within 5 years after DMEK. To ensure sufficiently high 6-month ECD, preoperative graft quality assessment should be optimized, and cellular stress induced to the graft should be minimized. Additionally, developing therapeutic options for the treatment of low postoperative ECD could further improve DMEK graft longevity.
目的
分析 6 个月时的内皮细胞密度（ECD）是否会影响 5 年后患有 Fuchs 角膜内皮营养不良（FECD）的接受 Descemet 膜内皮角膜移植术（DMEK）的眼的长期 ECD 结果和移植物存活率。
设计
回顾性队列研究。
参与者
共纳入 585 只 DMEK 眼。根据 6 个月 ECD 四分位数将研究组分为 4 组：第 1 组（n=146）ECD 为 313-1245 个细胞/mm、第 2 组（n=148）ECD 为 1246-1610 个细胞/mm、第 3 组（n=145）ECD 为 1611-1938 个细胞/mm、第 4 组（n=146）ECD 为 1939-2760 个细胞/mm。第 1 组进一步分为以下亚组：第 1a 组（n=36）ECD 为≤828 个细胞/mm、第 1b 组（n=37）ECD 为 829-1023 个细胞/mm、第 1c 组（n=37）ECD 为 1024-1140 个细胞/mm、第 1d 组（n=36）ECD 为 1141-1245 个细胞/mm。
方法
Descemet 膜内皮角膜移植术。
主要观察指标
长期 ECD、移植物存活率和术后并发症发生率。
结果
第 1 组 6 个月时的 ECD 从（n=146）的 951（±233）个细胞/mm 下降到 5 年时的 735（±216）个细胞/mm（n=99）。第 1 组移植物存活率在 5 年时为 0.95（95%置信区间[CI]，0.91-0.99]），低于第 2 组至第 4 组（P=0.001）。第 1a 亚组的 5 年移植物存活率为 0.79（95%CI，0.67-0.94），低于第 1b 至 1d 亚组（P=0.001）。术前 ECD 不影响移植物存活率（P=0.400），较高的 6 个月 ECD 值与较低的移植物失效率相关（风险比，0.994；95%CI，0.99-1.00；P=0.001）。
结论
6 个月 ECD 与 DMEK 移植物存活率相关。DMEK 后早期细胞丢失较多会对长期 ECD 结果和移植物存活率产生负面影响。6 个月 ECD 最低亚组（≤828 个细胞/mm）的移植物在 DMEK 后 5 年内失效率较高。为确保有足够高的 6 个月 ECD，应优化术前移植物质量评估，并尽量减少对移植物的细胞应激。此外，开发治疗低术后 ECD 的治疗方案可能进一步提高 DMEK 移植物的长期效果。
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