Narang Eye Care and Laser Centre, Ahmedabad, India.
Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India; and.
Cornea. 2024 Jul 1;43(7):860-865. doi: 10.1097/ICO.0000000000003383. Epub 2023 Sep 12.
The aim of this study was to analyze the outcomes of pre-Descemet endothelial keratoplasty (PDEK) for failed therapeutic penetrating keratoplasty.
This was a retrospective, interventional study that involved 12 eyes of 12 patients with failed therapeutic penetrating keratoplasty that underwent PDEK. All cases had a minimum follow-up of 12 months. The main outcome measures were best-corrected visual acuity, graft clarity, endothelial cell density loss, and graft survival. Corneal clarity was graded on a scale from 0 to 4, where grade 4 denoted an absolutely clear cornea and grade 0 denoted a totally opaque cornea. Three cases underwent PDEK, 6 cases PDEK with phacoemulsification, and 3 cases underwent PDEK with pupilloplasty.
The mean follow-up period for all cases was 18.5 ± 4.9 months. The mean preoperative and postoperative best-corrected visual acuity (in Snellen decimal equivalent) was 0.02 ± 0.01 and 0.54 ± 0.17, respectively, at the last follow-up. Postoperatively, corneal clarity grade 4 was present in 9 eyes, grade 3 in 2 eyes, and grade 2 in 1 eye. Mild subepithelial haze was noted in 2 eyes. The percentage of endothelial cell density loss was 28.2% ± 10.6%. No correlation was observed between the postoperative graft clarity and preoperative specular count (r = -0.021, P = 0.512). Rebubbling was performed for 1 eye that developed partial graft detachment in the first postoperative week. One patient had an episode of rejection that was managed with systemic and topical steroids.
In patients with failed therapeutic penetrating keratoplasty, PDEK can be a useful alternative for visual rehabilitation as it demonstrates favorable visual outcomes with a good graft survival rate.
本研究旨在分析预 Descemet 内皮层角膜移植术（PDEK）治疗失败的穿透性角膜移植术的结果。
这是一项回顾性、干预性研究，纳入了 12 例 12 只眼因治疗性穿透性角膜移植失败而接受 PDEK 的患者。所有病例的随访时间均至少为 12 个月。主要观察指标为最佳矫正视力、移植物清晰度、内皮细胞密度损失和移植物存活率。角膜清晰度评分从 0 到 4 级，其中 4 级表示角膜完全透明，0 级表示角膜完全不透明。3 例患者行 PDEK，6 例患者行 PDEK 联合超声乳化术，3 例患者行 PDEK 联合瞳孔成形术。
所有患者的平均随访时间为 18.5±4.9 个月。末次随访时，平均术前和术后最佳矫正视力（Snellen 十进制等效值）分别为 0.02±0.01 和 0.54±0.17。术后，9 只眼的角膜透明度为 4 级，2 只眼为 3 级，1 只眼为 2 级。2 只眼轻度上皮下混浊。内皮细胞密度损失百分比为 28.2%±10.6%。术后移植物清晰度与术前角膜内皮镜计数无相关性（r=-0.021，P=0.512）。1 只眼在术后第 1 周发生部分移植物脱离，行再次注气。1 例患者发生排斥反应，经全身和局部皮质类固醇治疗后缓解。
对于治疗性穿透性角膜移植失败的患者，PDEK 是一种有价值的替代方法，可提供良好的视力恢复效果和较高的移植物存活率。
