Department of Cornea, Cataract and Refractive Services, The Eye Foundation Eye Hospital, Coimbatore, India.
Indian J Ophthalmol. 2023 May;71(5):1862-1867. doi: 10.4103/IJO.IJO_2588_22.
To analyze the visual outcome and complications of Descemet stripping endothelial keratoplasty (DSEK) with their management in 256 eyes at a tertiary eye care center in southern India.
This is a retrospective interventional study of 62 months duration conducted at a tertiary eye care center in southern India. Two hundred and fifty-six eyes of 205 patients were included in the study after obtaining written informed consent from the patients. All cases of DSEK were performed by a single experienced surgeon. In all cases, donor dissection was performed manually. A Sheet's glide was inserted through the temporal corneal incision and donor button was placed on the Sheet's glide with the endothelial side down. The lenticule was separated and inserted into the anterior chamber by pushing the lenticule into the anterior chamber using Sinskey's hook. Any complication, either intraoperative or postoperative, was recorded and managed either medically or by appropriate surgical means.
The mean best corrected visual acuity (BCVA) before surgery was CF-1 m, which improved to 6/18 after surgery. Intraoperative donor graft perforation during dissection was seen in 12 cases, thin lenticule in three eyes, and repeated artificial Anterior Chamber (AC) collapse in three eyes. Dislocation of lenticule was the most common complication seen in 21 eyes, which was managed by graft repositioning and rebubbling. Eleven cases had minimal separation of the graft and seven cases had interface haze. Pupillary block glaucoma was seen in two cases that resolved with partial release of bubble. Surface infiltrate was seen in two cases, which was managed with topical antimicrobial agents. Primary graft failure was seen in two cases.
DSEK is a promising alternative to penetrating keratoplasty for corneal endothelial decompensation, but it also has its own merits and limitations, and most often, merits overweigh limitations.
分析在印度南部一家三级眼科中心进行的 256 只眼的撕囊内皮角膜移植术（DSEK）的视力结果和并发症，并对其进行管理。
这是一项在印度南部一家三级眼科中心进行的为期 62 个月的回顾性干预研究。在获得患者的书面知情同意后，研究纳入了 205 名患者的 256 只眼。所有 DSEK 均由一位经验丰富的外科医生完成。在所有情况下，均通过手动进行供体解剖。Sheet's glide 通过颞侧角膜切口插入，供体瓣内皮朝下放置在 Sheet's glide 上。通过使用 Sinskey's hook 将 Lenticule 推向前房，将 Lenticule 分离并插入前房。记录任何术中或术后并发症，并通过药物或适当的手术方式进行处理。
术前平均最佳矫正视力（BCVA）为 CF-1 m，术后提高至 6/18。术中在 12 例供体移植物在解剖过程中穿孔，3 例 Lenticule 较薄，3 例反复发生人工前房（AC）塌陷。最常见的并发症是 Lenticule 脱位，共 21 只眼，通过移植物重新定位和重新注气进行处理。11 例移植物有轻微分离，7 例有界面混浊。2 例发生瞳孔阻滞性青光眼，通过部分释放气泡得到解决。2 例出现表面浸润，通过局部使用抗菌药物进行处理。2 例发生原发性移植物失功。
DSEK 是角膜内皮失代偿的一种有前途的穿透性角膜移植替代方法，但它也有其自身的优点和局限性，而且通常优点多于局限性。
