Vaiano Agostino S, Greco Antonio, Greco Andrea, Toro Maria E, Leto Marco G, Savini Giacomo
Institute of Ophthalmology, Santa Croce e Carle Hospital, Cuneo, Italy.
IRCCS G.B. Bietti Foundation, Rome, Italy.
Eur J Ophthalmol. 2023 Nov;33(6):2201-2209. doi: 10.1177/11206721231166558. Epub 2023 Mar 28.
To evaluate a novel surgical combination of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and sutureless scleral fixation for Carlevale intraocular lens (SSF-Carlevale IOL) implantation to manage corneal endothelial decompensation when there is a concomitant need for secondary IOL fixation.
Clinical data collected from 10 eyes of 9 patients with bullous keratopathy (BK) who underwent combined UT-DSAEK and SSF-Carlevale IOL implantation in a single procedure were retrospectively analyzed. Anterior chamber IOL (4 cases), aphakia (4 cases, 1 of which associated with PEX), and previous trauma (2 cases) were the conditions responsible for BK. Corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), central corneal thickness (CCT), graft thickness (GT) and complications were recorded over a 12-month follow-up period.
In 90% (9/10) of eyes graft clarity was maintained during follow-up. The mean CDVA improved significantly (p < 0.0001) from 1.78 ± 0.76 logMAR preoperatively to 0.53 ± 0.3 logMAR at 12 months. ECD on average decreased from 2575 ± 125.3 cells/mm2 (donor tissue) to 1697 ± 133.3 cells/mm2 in 12 months. The mean CCT decreased from 870 ± 200 µm to 650 µm ± 9 at 12 months (ANOVA, p = 0.0005).
Combined UT-DSAEK and SSF-Carlevale IOL implantation was associated with good corneal graft survival and IOP control, with few complications. These findings suggest that this surgical approach is a practical option for patients requiring both treatment for corneal endothelial dysfunction and secondary IOL implantation.
评估一种新型手术组合，即超薄Descemet膜剥除自动内皮角膜移植术（UT-DSAEK）与无缝合巩膜固定Carlevale人工晶状体（SSF-Carlevale IOL）植入术，用于在需要二期人工晶状体固定时处理角膜内皮失代偿情况。
回顾性分析9例大泡性角膜病变（BK）患者10只眼的临床资料，这些患者在同一次手术中接受了UT-DSAEK与SSF-Carlevale IOL联合植入术。导致BK的病因包括前房型人工晶状体（4例）、无晶状体眼（4例，其中1例与假性剥脱综合征相关）和既往外伤（2例）。在12个月的随访期内记录矫正远视力（CDVA）、眼压（IOP）、内皮细胞密度（ECD）、中央角膜厚度（CCT）、植片厚度（GT）及并发症情况。
90%（9/10）的术眼在随访期间植片保持透明。平均CDVA从术前的1.78±0.76 logMAR显著改善（p<0.0001）至12个月时的0.53±0.3 logMAR。ECD在12个月内平均从2575±125.3个细胞/mm²（供体组织）降至1697±133.3个细胞/mm²。平均CCT在12个月时从870±200 µm降至650±9 µm（方差分析，p=0.0005）。
UT-DSAEK与SSF-Carlevale IOL联合植入术具有良好的角膜植片存活率和眼压控制效果，并发症较少。这些结果表明，对于需要同时治疗角膜内皮功能障碍和二期人工晶状体植入的患者，这种手术方法是一种可行的选择。
