Nishisako Sota, Yamaguchi Takefumi, Hirayama Masatoshi, Higa Kazunari, Aoki Dai, Sasaki Chiaki, Noma Hisashi, Shimazaki Jun
Cornea Center and Eye Bank, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan.
Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan.
Front Med (Lausanne). 2022 Feb 4;9:810536. doi: 10.3389/fmed.2022.810536. eCollection 2022.
To identify donor-related risk factors associated with graft endothelial failure and postoperative endothelial cell density (ECD) reduction after Descemet's stripping automated endothelial keratoplasty (DSAEK).
This was a single-center retrospective study conducted from July 2006-December 2016. We included 584 consecutive eyes (482 patients) that underwent DSAEK for the treatment of laser iridotomy-related bullous keratopathy (192 eyes), pseudophakic bullous keratopathy (137 eyes), regraft (96 eyes), Fuchs' endothelial corneal dystrophy (FECD; 59 eyes) and others (100 eyes). Twenty-three donor- and recipient-related risk factors potentially associated with graft failure and ECD reduction were assessed using Cox hazard models and linear mixed effect models.
The median age of the patients was 73.5 years (male; 35.6%). After DSAEK, ECD decreased from 2,674 cells/mm (95% confidence interval [CI]; 2,646-2,701) to 1,132 (1,076-1,190) at 12 months and 904 (845-963) at 24 months ( < 0.001). Fifty-five eyes (9.4%) had graft endothelial failure without rejection. This failure was associated with donor pseudophakic lens status (hazard ratio [HR]; 2.67, CI; 1.50-4.76, = 0.001) and preoperative endothelial folds (HR; 2.82, CI; 1.20-6.62, = 0.02). The incidence of graft endothelial failure in non-FECD patients was significantly higher among those receiving donor grafts with a pseudophakic lens status and preoperative presence of endothelial folds ( < 0.001). Postoperative ECD loss was significantly greater in eyes with these risk factors compared to those without ( = 0.007).
Pseudophakic status and/or presence of preoperative endothelial folds are the significant donor risk factors for endothelial failure in non-FECD patients.
确定与Descemet膜剥脱自动内皮角膜移植术（DSAEK）后移植片内皮功能衰竭及术后内皮细胞密度（ECD）降低相关的供体相关危险因素。
这是一项于2006年7月至2016年12月进行的单中心回顾性研究。我们纳入了连续584只眼（482例患者），这些患者因治疗激光虹膜切开术相关大泡性角膜病变（192只眼）、人工晶状体眼大泡性角膜病变（137只眼）、再次移植（96只眼）、Fuchs内皮角膜营养不良（FECD；59只眼）及其他情况（100只眼）而接受了DSAEK手术。使用Cox风险模型和线性混合效应模型评估了23个可能与移植失败和ECD降低相关的供体及受体相关危险因素。
患者的中位年龄为73.5岁（男性；35.6%）。DSAEK术后，ECD在12个月时从2674个细胞/mm²（95%置信区间[CI]；2646 - 2701）降至1132个（1076 - 1190），在24个月时降至904个（845 - 963）（P < 0.001）。55只眼（9.4%）发生了无排斥反应的移植片内皮功能衰竭。这种衰竭与供体人工晶状体状态（风险比[HR]；2.67，CI；1.50 - 4.76，P = 0.001）及术前内皮皱襞（HR；2.82，CI；1.20 - 6.62，P = 0.02）相关。在非FECD患者中，接受有晶状体状态供体移植片且术前存在内皮皱襞的患者，移植片内皮功能衰竭的发生率显著更高（P < 0.001）。与无这些危险因素的眼相比，有这些危险因素的眼术后ECD损失显著更大（P = 0.007）。
有晶状体状态和/或术前存在内皮皱襞是非FECD患者内皮功能衰竭的重要供体危险因素。
