Ramappa Muralidhar, Mohamed Ashik, Achanta Divya S Ramya, Tumati Chaitanya S Kiran, Chaurasia Sunita, Edward Deepak P
Centre for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, India.
The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India.
Cornea. 2021 Dec 1;40(12):1571-1580. doi: 10.1097/ICO.0000000000002811.
This study was to report the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in managing corneal endothelial disorders in children less than 14 years of age.
Medical records of 180 DSAEK performed, between 2008 and 2020, on 167 eyes of 111 children who had a visually significant endothelial dysfunction were retrospectively reviewed for the primary etiology of corneal decompensation, time of the onset and duration of cloudiness, preoperative visual acuity, the technique of endothelial keratoplasty, surgical modifications, and reintervention.
Median age at surgical intervention was 7.9 years (interquartile range, 5.2-11.2 years). At a median postinterventional follow-up of 2.5 years (interquartile range, 0.9-3.4 years), 86.2% (144 of 167 eyes, 95% confidence interval 79.9%-90.1%) maintained a clear graft. Median best-corrected visual acuity (logarithm of the minimum angle of resolution) improved from 1.45 ± 0.70 preoperatively to 0.90 ± 0.06 at the last follow-up visit (P < 0.0001). The cumulative overall long-term graft survival was 92.7%, 86.5%, and 77.7% at 1, 3, and 7 years, respectively. Cox proportional hazards regression analysis showed that the indication for DSAEK (P = 0.007; hazards ratio: 2.17 ± 0.62), age at surgery (P = 0.02; hazards ratio: 0.87 ± 0.05), and any subsequent intervention after DSAEK (P = 0.003; hazards ratio: 0.11 ± 0.08) were significant risk factors for DSAEK failure. The endothelial cell loss was 40.1% at 6 months, 45.4% at 1 year, 55.2% at 5 years, and 61.9% at 7 years.
DSAEK is a safe and effective surgical strategy in managing endothelial disorders among the pediatric age group.
本研究旨在报告Descemet膜剥脱自动内皮角膜移植术（DSAEK）治疗14岁以下儿童角膜内皮疾病的效果。
回顾性分析2008年至2020年间对111名患有明显内皮功能障碍的儿童的167只眼进行的180例DSAEK手术记录，以了解角膜失代偿的主要病因、混浊出现的时间和持续时间、术前视力、内皮角膜移植技术、手术改良及再次干预情况。
手术干预时的中位年龄为7.9岁（四分位间距为5.2 - 11.2岁）。在中位术后随访2.5年（四分位间距为0.9 - 3.4年）时，86.2%（167只眼中的144只，95%置信区间为79.9% - 90.1%）的移植片保持透明。最佳矫正视力（最小分辨角对数）中位数从术前的1.45±0.70提高到最后一次随访时的0.90±0.06（P < 0.0001）。1年、3年和7年时的累积总体长期移植片存活率分别为92.7%、86.5%和77.7%。Cox比例风险回归分析显示，DSAEK的适应证（P = 0.007；风险比：2.17±0.62）、手术年龄（P = 0.02；风险比：0.87±0.05）以及DSAEK术后的任何后续干预（P = 0.003；风险比：0.11±0.08）是DSAEK失败的显著危险因素。6个月时内皮细胞丢失率为40.1%，1年时为45.4%，5年时为55.2%，7年时为61.9%。
DSAEK是治疗儿童年龄组内皮疾病的一种安全有效的手术策略。
