目的:Descemet剥离内皮角膜移植术(DSEK)已成为后板层角膜移植术的首选方法,因为它能够用可行的供体薄片替换受损的宿主内皮。这项研究的目的是评估DSEK对手术结果和视力的影响。
方法:该研究于2019年11月至2021年10月进行,包括18例符合DSEK纳入标准的患者(18只眼)的样本。术前评估在手术前进行一次,虽然术后评估是在一个小时进行的,三,手术干预后六个月。本研究评估的主要变量包括人口统计学特征,视敏度,外科技术,和手术期间使用的手术并发症。使用IBMSPSS软件版本21(IBMCorp.,Armonk,NY,美国)。
结果:研究中患者的年龄范围为25至70岁,平均年龄为53.16±14.19岁。参与者为61%的男性和39%的女性。使用DSEK的主要原因是假晶状体大疱性角膜病变(61%)和穿透性角膜移植术(PK)后移植失败(17%)。其他适应症是无晶状体大疱性角膜病变(11%),大疱性角膜病变伴白内障(5%),和Fuchs的内皮营养不良(5%)。该研究包括18只眼:14只眼接受了DSEK,两名患者接受了DSEK小切口白内障手术(SICS)和后房型人工晶状体(PCIOL)植入,两人接受了巩膜固定FIL的DSEK。在六个月的随访中观察到最佳矫正视力(BCVA)的显着改善(0.73±0.37vs.术前1.73±0.59logMAR)。在供体角膜解剖期间,纽扣洞是主要问题,11%的时间发生。还观察到Descemet的穿孔和供体制备厚度变化。反向供体展开,不完全DM剥离,和捐助者按钮移位迅速解决和管理。术后移植物失败发生在22%的病例中,而急性移植物排斥反应发生在11%。接枝位错,瞳孔阻滞,和继发性青光眼的患病率分别为5%.
结论:Descemet剥脱内皮角膜移植术是一种安全有效的治疗角膜内皮功能紊乱的方法,特别是在没有疤痕的情况下。手术技巧对于达到预期的结果至关重要。由于其技术优势和可控制的风险,Descemet剥离内皮角膜移植术优于常规角膜移植术治疗内皮功能障碍。我们的研究表明,通过DSEK可以显着提高视力。尽管术后并发症可控,对患者和医疗专业人员进行外科复杂性教育至关重要。Descemet剥离内皮角膜移植术对于治疗内皮疾病似乎很有希望,但它的长期影响必须研究。
OBJECTIVE: Descemet\'s stripping endothelial keratoplasty (DSEK) has emerged as the preferred method for posterior lamellar keratoplasty, as it enables the replacement of the compromised host endothelium with a viable donor lamella. The objective of this study was to assess the impact of DSEK on surgical outcomes and visual acuity.
METHODS: The research was carried out from November 2019 to October 2021, encompassing a sample of 18 patients (18 eyes) who satisfied the inclusion criteria for DSEK. The pre-operative evaluation was performed once before the surgery, while post-operative evaluations were conducted at one, three, and six months after the surgical intervention. The main variables assessed in this study encompassed demographic characteristics, visual acuity, surgical techniques, and surgical complications employed during the surgical procedure. The collected data were statistically analyzed using IBM SPSS software version 21 (IBM Corp., Armonk, NY, USA).
RESULTS: Patients in the study ranged in age from 25 to 70, with a mean age of 53.16 ± 14.19 years. The participants were 61% male and 39% female. The main reasons for DSEK use were pseudophakic bullous keratopathy (61%) and post-penetrating keratoplasty (PK) graft failure (17%). The other indications were aphakic bullous keratopathy (11%), bullous keratopathy with cataracts (5%), and Fuchs\'s endothelial dystrophy (5%). The study included 18 eyes: 14 eyes underwent DSEK, two underwent DSEK with small-incision cataract surgery (SICS) and posterior chamber intraocular lens (PCIOL) implantation, and two underwent DSEK with scleral-fixated FIL. A significant improvement in best-corrected visual acuity (BCVA) was observed at six-month follow-up (0.73 ± 0.37 vs. 1.73 ± 0.59 logMAR pre-operatively). During donor cornea dissection, buttonholing was the main concern, occurring 11% of the time. Descemet\'s perforation and donor preparation thickness variations were also observed. Reverse donor unfolding, incomplete DM stripping, and donor button displacement were quickly addressed and managed. Post-operative graft failure occurred in 22% of cases, while acute graft rejection occurred in 11%. Graft dislocation, pupillary block, and secondary glaucoma each had a 5% prevalence.
CONCLUSIONS: Descemet\'s stripping endothelial keratoplasty is a safe and effective treatment for corneal endothelial disorders, particularly in cases where scarring is not present. Surgical skills are essential to achieving the desired results. Descemet\'s stripping endothelial keratoplasty is favored over conventional keratoplasty for endothelial dysfunction due to its technical advantages and manageable risks. Our research demonstrates a significant improvement in visual acuity through DSEK. Despite manageable post-operative complications, it is vital to educate patients and medical professionals on surgical complexities. Descemet\'s stripping endothelial keratoplasty appears promising for the treatment of endothelial disorders, but its long-term implications must be studied.