Anterior Segment Division (D.A.-D., A. AlRajhi, A. Alqarni, M.A.A.), King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; Department of Ophthalmology (A. AlRajhi), Alfaisal University, Riyadh, Saudi Arabia; Department of Ophthalmology (A. AlHazzani), King Abdulaziz University Hospital, Riyadh, Saudi Arabia; and Department of Optometry (R.A.), King Saud University, Riyadh, Saudi Arabia.
Eye Contact Lens. 2022 Dec 1;48(12):521-526. doi: 10.1097/ICL.0000000000000942. Epub 2022 Sep 21.
The purpose of this study was to compare the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PKP) in patients with congenital hereditary endothelial dystrophy (CHED).
This was a retrospective, comparative study of all the patients with a histopathological diagnosis of CHED who underwent PKP or DSAEK between January 1, 1990, and December 31, 2016. All the cases were included except those patients who had clear grafts but did not complete 2 years of postoperative follow-up. The main outcome measure was graft clarity 2 years after surgery.
There were 111 eyes of 63 patients. Seventy-six eyes underwent PKP, and 35 eyes underwent DSAEK. The median age at surgery was 6.8 years in the PKP group and 10.32 years in the DSAEK group. At 2 years postoperatively, clear grafts were noted in 66 of 76 (86.8%) eyes in the PKP group and 30 of 35 (85.7%) eyes in the DSAEK group. At the last follow-up, 80.3% of PKP grafts and 82.8% of DSAEK grafts were clear ( P =0.5). The type and timing of complications differed between the 2 groups. The PKP group had a statistically significant higher rate of graft rejection (19.5%) versus the DSAEK group (0%) ( P =0.01). DSAEK complications were mainly lenticule detachment that developed within one month postoperatively. There was no statistically significant difference in the visual outcomes at the last follow-up between the groups.
Endothelial keratoplasty is a safe alternative to conventional PKP in CHED. The visual outcome and survival rates were comparable, but DSAEK had a lower rejection rate and fewer suture-related complications.
本研究旨在比较先天性遗传性内皮营养不良（CHED）患者行去表皮角膜内皮移植术（DSAEK）和穿透性角膜移植术（PKP）的结局。
这是一项回顾性比较研究，纳入 1990 年 1 月 1 日至 2016 年 12 月 31 日期间所有经组织病理学诊断为 CHED 而行 PKP 或 DSAEK 的患者。除了那些移植片清晰但术后未完成 2 年随访的患者外，所有病例均被纳入研究。主要观察指标为术后 2 年的移植片清晰度。
共纳入 63 例患者的 111 只眼。76 只眼行 PKP，35 只眼行 DSAEK。PKP 组患者的中位手术年龄为 6.8 岁，DSAEK 组为 10.32 岁。术后 2 年时，PKP 组 76 只眼中有 66 只（86.8%）和 DSAEK 组 35 只眼中有 30 只（85.7%）的移植片清晰。末次随访时，PKP 组和 DSAEK 组的透明移植片分别占 80.3%和 82.8%（P=0.5）。两组的并发症类型和发生时间不同。PKP 组移植排斥反应发生率（19.5%）显著高于 DSAEK 组（0%）（P=0.01）。DSAEK 组的主要并发症为术后 1 个月内发生的角膜基质内透镜移位。两组末次随访时的视力结果无统计学差异。
在 CHED 中，内皮角膜移植术是一种替代传统 PKP 的安全方法。其视力结果和存活率相当，但 DSAEK 的排斥反应发生率更低，缝线相关并发症更少。
