Case Western Reserve University Department of Ophthalmology and Visual Sciences and University Hospitals Eye Institute, Cleveland, OH.
Cornea Image Analysis Reading Center (CIARC), University Hospitals Eye Institute and Case Western Reserve University Department of Ophthalmology and Visual Sciences, Cleveland, OH.
Cornea. 2022 Dec 1;41(12):1539-1544. doi: 10.1097/ICO.0000000000003108. Epub 2022 Sep 9.
The purpose of this study was to evaluate outcomes of Descemet stripping automated endothelial keratoplasty comparing exchange with fresh intermediate-term cold storage solution after lenticule preparation versus reuse of the original solution in the Cornea Preservation Time Study.
In the Cornea Preservation Time Study, 508 donor corneas had lenticules prepared by the eye bank with fresh solution exchange (Fresh group) and 283 with reuse of the original solution (Original group). Storage time for all donors was ≤11 days. Graft success rates, central endothelial cell loss at 3 years, and frequency of positive donor rim cultures were compared between the 2 groups.
The 3-year graft success rate (95% confidence interval) was 93.4% (90.7%-95.3%) in the Fresh group and 95.2% (91.8%-97.2%) in the Original group (adjusted hazard ratio for graft failure = 0.64, 95% confidence interval, 0.33-1.24, P = 0.19). The mean percentage endothelial cell loss was significantly greater in the Fresh group versus Original group (45% ± 22% vs. 38% ± 20%, respectively, P = 0.004). Cultures were positive in 4 (1.5%) of 267 donor rims (3 fungal and 1 bacterial) in the Fresh group and in 4 (2.5%) of 158 in the Original group ( P = 0.57). There were 2 postoperative infections in the Original group and none in the Fresh group.
The use of the original intermediate-term cold storage solution did not reduce the 3-year graft success rate compared with exchanging with fresh solution after lenticule preparation for Descemet stripping automated endothelial keratoplasty, while the frequency of positive donor rim cultures did not significantly differ between groups.
本研究旨在评估与新鲜中期冷藏液交换后进行去内皮自动角膜内皮移植术（Descemet stripping automated endothelial keratoplasty，DSEA）的结果，比较 Lenticule 制备时使用新鲜溶液交换（新鲜组）与重复使用原始溶液（原始组）的情况。
在角膜保存时间研究中，508 个供体角膜由眼库使用新鲜溶液交换（新鲜组）制备 Lenticule，283 个供体角膜使用原始溶液重复使用（原始组）。所有供体的储存时间均≤11 天。比较两组之间的移植物成功率、3 年后中央内皮细胞丢失率和供体边缘培养阳性的频率。
新鲜组 3 年移植物成功率（95%置信区间）为 93.4%（90.7%-95.3%），原始组为 95.2%（91.8%-97.2%）（移植物失败的调整危险比=0.64，95%置信区间，0.33-1.24，P=0.19）。新鲜组的平均内皮细胞丢失百分比明显大于原始组（分别为 45%±22%和 38%±20%，P=0.004）。新鲜组 267 个供体边缘中有 4 个（1.5%）培养阳性（3 个真菌和 1 个细菌），原始组 158 个中有 4 个（2.5%）培养阳性（P=0.57）。原始组有 2 例术后感染，新鲜组无感染。
与 Lenticule 制备后使用新鲜溶液交换相比，DSEA 术中重复使用原始中期冷藏液不会降低 3 年移植物成功率，而两组间供体边缘培养阳性的频率无显著差异。
