飞秒激光辅助 Descemet 撕囊内皮角膜移植术：内皮细胞丢失和移植物存活率的 2 年结果。
Femtosecond laser semi-assisted Descemet stripping endothelial keratoplasty: 2-year outcomes of endothelial cell loss and graft survival.
机构信息
Department of Ophthalmology, Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, 372 Jingsi Road, Jinan, 250021, China.
出版信息
Graefes Arch Clin Exp Ophthalmol. 2022 Jan;260(1):181-189. doi: 10.1007/s00417-021-05383-x. Epub 2021 Aug 31.
PURPOSE
To assess 2-year endothelial cell loss and graft survival after femtosecond laser semi-assisted Descemet stripping endothelial keratoplasty (FLS-DSEK).
METHODS
In this prospective and noncomparative study carried out at Eye Hospital of Shandong First Medical University, 85 eyes (84 patients) with endothelial dysfunction receiving FLS-DSEK (n=62, 75.9%) or FLS-DSEK combined with phacoemulsification cataract surgery and intraocular lens implantation (n=23, 27.1%) from 2013 through 2016 were included. The graft endothelial cell loss, endothelial graft thickness, visual acuity, and complications after surgery were evaluated.
RESULTS
Thin endothelial grafts were all successfully prepared, with no occurrence of perforation. The rate of endothelial cell loss was 17.4%, 18.8%, 19.9%, and 26.7%, and the central graft thickness was 113±54 μm, 102±40 μm, 101±28 μm, and 96±23 μm at 3, 6, 12, and 24 months, respectively. The median best-corrected visual acuity was 0.4 logMAR (range, 0-2 logMAR) at 24 months, demonstrating a significant difference from that before surgery (2 logMAR; range, 0.2-3 logMAR) (T=187.5, P<.001). Partial graft dislocation was the most common postoperative complication, with an occurrence rate of 14% (n=12), and it was associated with an abnormal iris-lens diaphragm (r=.35, P<.001). The other complications included a high intraocular pressure (n=5, 6%), endothelial graft rejection (n=4, 5%), and pupillary block (n=1, 1%). Endothelial graft decompensation occurred in the two eyes, and 98% (n=83) of the grafts survived at 24 months.
CONCLUSIONS
Data of the study suggest that the treatment using FLS-DSEK seems to be promising and might be considered a feasible choice in patients with endothelial dysfunction.
TRIAL REGISTRATION
- Date of registration: 2021-02-18 2.
TRIAL REGISTRATION NUMBER
ChiCTR2100044091 3. Registration site: https://www.chictr.org.cn/.
目的
评估飞秒激光辅助撕囊的 Descemet 膜内皮角膜移植术（FLS-DSEK）后 2 年的内皮细胞丢失和移植物存活率。
方法
本研究为前瞻性、非对照研究，于 2013 年至 2016 年在山东第一医科大学附属眼科医院开展，纳入 85 只眼（84 例患者），这些眼因内皮功能障碍接受了 FLS-DSEK（n=62，75.9%）或 FLS-DSEK 联合白内障超声乳化吸除术和人工晶状体植入术（n=23，27.1%）。评估术后移植物内皮细胞丢失、内皮移植物厚度、视力和并发症。
结果
所有薄的内皮移植物均成功制备，无穿孔发生。内皮细胞丢失率分别为 17.4%、18.8%、19.9%和 26.7%，术后 3、6、12 和 24 个月中央移植物厚度分别为 113±54 μm、102±40 μm、101±28 μm 和 96±23 μm。术后 24 个月最佳矫正视力中位数为 0.4 logMAR（范围 0-2 logMAR），与术前相比差异有统计学意义（2 logMAR；范围 0.2-3 logMAR）（T=187.5，P<.001）。部分移植物脱位是最常见的术后并发症，发生率为 14%（n=12），与异常虹膜晶状体膈（r=.35，P<.001）相关。其他并发症包括高眼压（n=5，6%）、内皮移植物排斥（n=4，5%）和瞳孔阻滞（n=1，1%）。有 2 只眼发生内皮移植物失代偿，98%（n=83）的移植物在 24 个月时存活。
结论
研究数据表明，采用 FLS-DSEK 的治疗方法似乎很有前景，可能是内皮功能障碍患者的一种可行选择。
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