内皮角膜移植术后全身疾病与解剖学转归的关系

The relationship between systemic disorders and anatomical outcomes after Descemet membrane endothelial keratoplasty.

作者信息

Topcu Husna, Yildiz Burcin Kepez, Yildirim Yusuf, Agca Alper

机构信息

Department of Ophthalmology, Inebolu State Hospital, Kastamonu, Turkey.

University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.

出版信息

Arq Bras Oftalmol. 2022 Feb 14;85(6):572-577. doi: 10.5935/0004-2749.20220087. eCollection 2022.

DOI:10.5935/0004-2749.20220087

PMID:35170644

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11826675/

Abstract

PURPOSE

The aim of this study was to investigate the association of anatomical outcomes and medications of patients with systemic diseases who underwent Descemet membrane endothelial keratoplasty with donor factors.

METHODS

Sixty nondiabetic donors of endothelial grafts and 60 patients who underwent operation by a single surgeon were included in this retrospective study. The patients' data, including the presence of diabetes mellitus and hypertension, antidiabetic-antihypertensive medications, and intracameral tamponades and anatomical outcomes, were recorded. The donor data were obtained from eye bank records.

RESULTS

Eighteen patients had type 2 diabetes mellitus (30%) and 34 had hypertension (56.6%). Among the patients with diabetes mellitus, 13 were receiving a single-agent antidiabetic drug, 4 were receiving dual oral antidiabetic therapy, and 1 was receiving insulin therapy. Among the hypertensive patients, 11 had monotherapy and 23 had dual antihypertensive therapy. Postoperatively, 35 patients (58.3%) had an endothelial attachment, 8 (13.3%) received reinjection, 7 (11.7%) required re-Descemet membrane endothelial keratoplasty, and 10 (16.7%) underwent penetrating keratoplasty. The mean donor age was 51.2 ± 14.1 years. The most common cause of donor death was cardiopulmonary arrest (36/60 cases; 60.0%). Regression analysis revealed that the presence of diabetes mellitus significantly disrupted graft attachment (p=0.034), while the presence of hypertension, antidiabetic and antihypertensive medication use, and the type of tamponade used in the patients, and the age, sex, cause of death, and specular endothelial cell count of donors were not statistically significantly associated with graft attachment (p>0.05).

CONCLUSION

In this study, the anatomical outcomes of Descemet membrane endothelial keratoplasty surgery were affected by recipient and donor factors. The presence of diabetes mellitus in the recipient significantly negatively affected graft attachment.

摘要

目的

本研究旨在探讨接受Descemet膜内皮角膜移植术的全身性疾病患者的解剖学结局及用药情况与供体因素之间的关联。

方法

本回顾性研究纳入了60例非糖尿病内皮移植供体及60例由单一外科医生实施手术的患者。记录患者数据，包括糖尿病和高血压的患病情况、抗糖尿病-抗高血压药物使用情况、前房内填塞情况及解剖学结局。供体数据来自眼库记录。

结果

18例患者患有2型糖尿病（30%），34例患有高血压（56.6%）。在糖尿病患者中，13例接受单药抗糖尿病治疗，4例接受双药口服抗糖尿病治疗，1例接受胰岛素治疗。在高血压患者中，11例接受单药治疗，23例接受双药抗高血压治疗。术后，35例患者（58.3%）实现内皮附着，8例（13.3%）接受再次注射，7例（11.7%）需要再次进行Descemet膜内皮角膜移植术，10例（16.7%）接受穿透性角膜移植术。供体平均年龄为51.2±14.1岁。供体死亡的最常见原因是心肺骤停（36/60例；60.0%）。回归分析显示，糖尿病的存在显著破坏了移植物附着（p=0.034），而高血压的存在、抗糖尿病和抗高血压药物的使用、患者使用的填塞类型以及供体的年龄、性别、死亡原因和镜面内皮细胞计数与移植物附着无统计学显著关联（p>0.05）。