Department of Cornea and Refractive Surgery, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India.
Department of Cornea and Refractive Services and Biostatistician, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India.
Indian J Ophthalmol. 2022 Jan;70(1):95-99. doi: 10.4103/ijo.IJO_663_21.
To assess the long-term outcome of graft insertion by taco technique through a 2.8-mm clear corneal incision in patients undergoing Descemet's stripping automated endothelial keratoplasty (DSAEK).
This is a retrospective interventional case series of 77 eyes of 75 patients who underwent DSAEK in a tertiary eye hospital. The DSAEK donor grafts were folded to an uneven 70/30 taco and held at a single point using Utrata forceps. All insertions were through a 2.8-mm clear corneal incision except the two aphakic patients requiring combined SFIOL implantation. All patients underwent a comprehensive eye examination preoperatively and were followed up to 6 years postoperatively. Visual outcomes, graft clarity, and complications of all and endothelial cell loss in 22 patients with available postop specular microscopy were analyzed.
Overall, 59 (76.6%) had clear grafts until the final follow-up. Visual acuity improved in 48 (62.3%) from an average of 1.3 to 0.8 logMAR (P = 0.0001). Vision was maintained in seven and worsened in four eyes. Grafts failed in 18 (23.3%) eyes: seven (9%) were primary failures, two post rejection, four done for failed PK did not clear, four due to worsening of preexisting glaucoma, and one noncompliant failed eventually. Average endothelial cell density reduction was 26.3% (mean preop donor 2419 to postop 1779 cells/mm; P = 0.000).
Our study shows good long-term clinical outcome of DSAEK using Taco technique through a 2.8-mm clear corneal incision in a tertiary hospital.
通过 2.8mm 透明角膜切口评估经 tacO 技术行穿透性角膜移植术（DSAEK）中移植物插入的长期结果。
这是一项回顾性的干预性病例系列研究，纳入了 75 例 77 只眼在三级眼科医院接受 DSAEK 的患者。DSAEK 供体移植物折叠成不均匀的 70/30taco，并使用 Utrata 夹单点夹持。除了 2 例需要联合 SFIOL 植入的无晶状体患者外，所有插入均通过 2.8mm 透明角膜切口进行。所有患者术前均进行全面眼科检查，并随访至术后 6 年。分析所有患者的视力结果、移植物清晰度和并发症，以及 22 例可提供术后共焦显微镜的患者的内皮细胞丢失情况。
总的来说，59 只眼（76.6%）在最后一次随访时移植物仍清晰。48 只眼（62.3%）的视力从平均 1.3logMAR 提高到 0.8logMAR（P=0.0001）。7 只眼视力保持不变，4 只眼视力恶化。18 只眼移植物失败：7 只眼（9%）为原发性失败，2 只眼继发于排斥反应，4 只眼因 PK 失败未清除，4 只眼由于先前存在的青光眼恶化，1 只眼因不依从而最终失败。平均内皮细胞密度下降 26.3%（术前供体平均 2419 个细胞/mm2，术后 1779 个细胞/mm2；P=0.000）。
我们的研究表明，在三级医院，通过 2.8mm 透明角膜切口使用 tacO 技术行 DSAEK 可获得良好的长期临床效果。
