DSAEK治疗PKP术后内皮失代偿患者的植片存活率及相关因素分析

Descemet′s stripping endothelial keratoplasty (DSAEK) in failed penetrating keratoplasty patients: graft survival rate and its associated factors

目的探讨角膜后弹力层剥除自动角膜刀取材内皮移植术(DSAEK)治疗穿透性角膜移植手术(PKP)后内皮失代偿患者的植片存活情况,并对相关因素进行分析。方法回顾性系列病例研究。收集2009年6月至2017年9月在北京大学第三医院眼科中心就诊并接受DSAEK治疗PKP后内皮失代偿的患者51例(51只眼),年龄(43.3±21.0)岁,男性36例,女性15例。收集患者人口学资料、手术方式、并发症、随访时间、植片最终状态以及相关术前、术后危险因素的资料。采用Kaplan-Meier方法计算植片累积存活率;Cox回归模型探究各因素对植片存活的影响。结果51只眼中,植片总存活率为78%(40/51)。术后1年、2年的植片总体累积存活率分别为85%(95%CI:0.73~0.96)、69%(95%CI:0.52~0.86),中位生存时间为42个月。DSAEK植片直径、术后眼压与植片的远期存活存在相关性。DSAEK植片直径大是植片存活的保护性因素(HR=0.29,95%CI:0.12~0.73)。而术后高眼压则是其风险因素(HR=1.08,95%CI:1.00~1.16;HR=1.10,95%CI:1.01~1.12)。年龄、性别、晶状体状态、既往PKP次数、既往青光眼手术史对植片的远期存活的影响均不显著(P>0.05)。结论应用DSAEK方式治疗PKP术后内皮失代偿是一种有效的方法,植片具有良好的长期存活率。选择大直径的植片有利于植片的长期存活,而术后眼压升高则是植片失败的风险因素。

Objective To explore graft survival rate and its associated factors of DSAEK in patients with endothelial decompensation after penetrating keratoplasty (PKP). Methods A retrospective case study was conducted, including 51 patients (51 eyes) that underwent DSAEK for endothelial decompensation after PKP in Department of Ophthalmology in Peking University Third Hospital from June 2009 to September 2017. The mean recipient age was (43.3±21.0) years. There were 36 males and 15 females. Data comprising demographic details,surgical methods, complications,follow-up durations,final states of grafts,preoperative and postoperative risk factors were collected. Kaplan-Meier analysis was used to determine the cumulative probability of graft survival. Cox regression model was developed to examine for factors associated with graft survival. Results Among 51 eyes,the overall graft survival rate was 78%(40/51). The cumulative probability was 85%(95%CI: 0.73-0.96) and 69%(95%CI: 0.52-0.86) at 1 year and 2 years, respectively. The median survival time was 42 months. The diameter of DSAEK graft and postoperative intraocular pressure correlated with the long-term survival of graft. Larger diameter of DSAEK graft was a protective factor for graft survival (HR=0.29, 95%CI: 0.12-0.73), while postoperative high intraocular pressure was a risk factor (HR=1.08, 95%CI: 1.00-1.16, HR=1.10, 95%CI:1.01-1.12). Recipient age, sex, lens status, the number of previous PKPs and previous glaucoma surgery had no significant effect on long-term survival (P>0.05). Conclusions DSAEK is an effective treatment for endothelial decompensation after PKP,with favorable graft survival rate. Larger diameter of graft is beneficial to the long-term survival,while high postoperative intraocular pressure is a risk factor for graft failure.