Descemet-membrane endothelial keratoplasty in patients with retinal comorbidity -a prospective cohort study

AIM： To investigate indications, surgical challenges, and outcome of Descemet -membrane endothelial keratoplasty （DMEK） in patients with retinal comorbidities （RC）. METHODS： In a prospective cohort study, 8 eyes of 8 DMEK-patients with known RC were compared to 38 eyes of 38 DMEK-patients without RC. The duration of surgery, the degree of difficulty graded by the surgeon, and the complications through DMEK-surgery were analyzed for each patient. The best-corrected visual acuity （BCVA）, the endothelial cell count, the intraocular pressure, and the subjective satisfaction was evaluated after a 6-month follow-up. Data were compared applying the non-parametric Wilcoxon-, Chi-square- and Fisher＇s-exact-test with P≤ 0. 05 as level of significance. RESULTS： RC-patients had dry age-related macular degeneration （n=4） or history of pars-plana vitrectomy （n=4）. The main indication for DMEK was pain due to bullous keratopathy for the RC-patlents （n=7, 88%） and visual impairment due to Fuchs endothelial keratoplasty for the non-RC-patients （n=33, 87% ）. The BCVA increased for both groups （P=0.01, P〈0.001） and all corneas cleared. For the RC-patients, the subjective satisfaction improved significantly （P=0.02）. Oil-filling and missing support of the vitreous body complicated surgery in vitrectomized eyes. CONCLUSION： DMEK is a favorable technique to treat endothelial disorders even if patients suffer from a retinal comorbidity. By enhancing the corneal clarity, it enables retinal examination or intraocular surgery and increases the patients satisfaction. However, in vitrectomized or silicone-oil filled eyes, the duration of surgery and degree of complexity are increased. An experienced surgeon should perform DMEK in these patients. Clinical trial registration number： DRKS00007566.

Glaucoma drainage device implantation and cyclophotocoagulation in the management of refractory glaucoma after Descemet-stripping automated endothelial keratoplasty

AIM:To compare the surgical outcomes of glaucoma drainage device implantation(GDI)and trans-scleral neodymium:YAG cyclophotocoagulation(CPC)in the management of refractory glaucoma after Descemetstripping automated endothelial keratoplasty(DSAEK).METHODS:This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery(15 with GDI and 14 with CPC).The main outcome measures were intraocular pressure(IOP),glaucoma surgery success rate(defined as IOP of 6–21 mm Hg without additional anti-glaucoma operation),number of glaucoma medications,endothelial graft status,and best-corrected visual acuity(BCVA).RESULTS:The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries,both for the GDI and CPC groups.Both groups showed significant IOP reduction after glaucoma surgery.The GDI group presented a significantly higher success rate in IOP control than the CPC group(60%vs 21.4%,P=0.03).Both procedures significantly decreased the number of glaucoma medications(P=0.03).Forty percent and 57%of cases in the GDI and the CPC group,respectively,experienced endothelial graft failure during follow-up(P=0.36).Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group.CONCLUSION:Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK.GDI is preferable to CPC in refractory glaucoma cases after DSAEK,as it manifests a significantly higher success rate for IOP control,similar endothelial graft failure rate,and relatively preserves BCVA than CPC.

Visual acuity and endothelial cell density with respect to the graft thickness in Descemet's stripping automated endothelial keratoplasty: one year results

AIM: To evaluate the visual acuity and endothelial cell density according to the thickness in Descemet’s stripping automated endothelial keratoplasty(DSAEK)one year after surgery.METHODS: DSAEK patients’ data were reviewed. Thirty seven eyes of 37 patients who underwent DSAEK for pseudophakic bullous keratopathy(PBK) were included in this study. Graft thickness was measured with optical coherence tomography(OCT) 12 mo after DSAEK. Eyes were divided into 3 groups based on the graft thickness:thick(】200 μm), medium-thick(150-200 μm) and thin(【150 μm). Best corrected visual acuity(BCVA),endothelial cells density(ECD) and complications were assessed and comparisons were done between groups.RESULTS: Median thickness of postoperative grafts was 188(range 73-317 μm). There was no significant difference in age, sex, preoperative BCVA, or follow-up period between DSAEK groups. At postoperative 12 mo,mean BCVA was 0.28±0.10 in thick graft group, 0.52±0.08 in medium-thick graft group, and 0.72 ±0.06 in thin graft group. Thin grafts showed better postoperative BCVA as compared with the medium-thick and thick grafts(P =0.001). Thick graft group had 1637.44 ±88.19-mm2,medium thick graft had 1764.50±34.28-mm2 and thin graft group had 1845.30 ±65.62-mm2. Thin graft group had better ECD at 12 mo after surgery(P =0.001).CONCLUSION: Thin grafts after DSAEK ensure better visual rehabilitation. Eyes with thin grafts had significantly lesser loss of ECD compared to eyes withmedium-thick and thick grafts one year after surgery.

Clinical results of non-Descemet stripping endothelial keratoplasty

AIM： To investigate the impact of non-Descemet stripping endothelial keratoplasty（non-DSEK） on graft rejection rate,and its overall procedural effectiveness in patients.METHODS： Non-DSEK was performed on 65 eyes of 64 patients,and the procedural outcomes,including rejection episodes,failure and dislocation of the grafts,best corrected visual acuity（BCVA）,endothelial cell density（ECD）,and other complications,were analyzed retrospectively.RESULTS： Of the 65 eyes,63 recovered from bullous keratopathy with a clear cornea.The mean follow-up time was 26.4mo（range,6-84mo）.The mean BCVA improved from 1.70 log MAR preoperatively to 0.54 log MAR at 3mo,0.46 logM AR at 6mo,and 0.37 logM AR at 1y after surgery.The postoperative donor ECD of the 25 patients who successfully underwent specular microscopic examination was 1918±534 cells/mm^2（range,637 to 3056 cells/mm^2）,and the mean endothelial cell loss was 41.9% at 24 mo postoperatively.One eye developed secondary glaucoma and required regrafting via penetrating keratoplasty（PKP）.Another eye had postoperative graft failure due to rejection at 26 mo.Postoperative graft dislocation occurred in eight eyes.All of the eight dislocated grafts were reattached using air reinjection.CONCLUSION： Immunological graft rejection of the donor graft rarely occurs in non-DSEK.Therefore,non-DSEK is a safe,concise,and effective alternative to restore corneal decompensation when the Descemet membrane is disease-free.

Changes in endothelial cell density following penetrating keratoplasty and deep anterior lamellar keratoplasty

· AIM: To compare the corneal endothelial cell density (ECD) of clear grafts after penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK). · METHODS: The study included 44 and 54 patients treated with PK and DALK, respectively, between March 2006 and April 2010. Corneal ECD was examined using specular microscopy at postoperative 1, 3, 6, 12, and 18 months, and the values were compared. · RESULTS: Corneal ECD reduction in the PK group was 7.4%, 15.2%, 23.5%, and 28.9% at 3, 6, 12 and 18 months respectively after surgery, compared with 4.2 % in the first month (P <0.01). These figures were 3.0%, 6.7%, 7.2%, and 7.7% at 3, 6, 12 and 18 months respectively, compared with 2.2 % in the first month in the DALK group (P >0.05). · CONCLUSION: Compared with DALK,PK significantly reduced ECD of the clear grafts. These results suggest that survival of endothelial cells in grafts is better after DALK than after PK. ·

Combined Descemet stripping automated endothelial keratoplasty and intravitreal dexamethasone implant for concomitant pseudophakic bullous keratopathy and cystoid macular edema

Dear Editor,Endothelial cell density decreases with age and in various ocular conditions,including corneal endotheliitis,uveitis,pseudoexfoliation syndrome,and birth injury(1)The reduction of endothelial cell density is exacerbated over time after intraocular surgery(1)Descemet stripping automated endothelial keratoplasty(DSAEK)is considered the primary procedure for patients with only endothelial dysfunction.

Descemet stripping automated endothelial keratoplasty in phakic eyes:incision modification reducing cataract formation

AIM： To evaluate the efficacy of a technical modification to reduce the incidence of traumatic cataract induced by Descemet stripping automated endothelial keratoplasty（DSAEK） performed in phakic eyes. METHODS： A retrospective cohort study. The records of all patients with a clear crystalline lens and endothelial failure that underwent modified DSAEK at our insitution were reviewed. In this modification, in order to avoid inadvertent touch of the insertion forceps against the exposed crystalline lens while passing across the anterior chamber, the incision sites were shifted from the standard 9 and 3 o＇clock positions, superiorly to the 10 and 2 o＇clock position respectively. Formation of typically traumatic, anterior subcapsular cataract in these patients was compared to that observed in a cohort including all the patients with a clear crystalline lens and endothelial failure that underwent conventional DSAEK at our institution.RESULTS： The study group included 49 eyes following modified DSAEK and the control group included 35 eyes following DSAEK with conventional incision sites. Anterior subcapsular cataract occurring 4 mo or less postoperatively was identified in 2 of 49（4%） eyes in the study group and 7 of 35（20%） eyes in the control group. The rates of traumatic cataract were significantly higher in the control group in comparison to the study group（P=0.03, RR=4.9, 95%CI 1.08-22.1）.CONCLUSION： Traumatic cataract formation following phakic DSAEK may be avoided with a simple modification to the position of the incision sites.

Complications and outcomes of descemet stripping automated endothelial keratoplasty with artisan aphakia intraocular lens implantation

AIM： To evaluate the complications and outcomes of descemet stripping automated endothelial keratoplasty（DSAEK） combined with artisan aphakia intraocular lens（IOL） implantation in severely damaged eyes without capsular support.METHODS： DSAEK combined with artisan iris claw IOL implantation was performed on 29 eyes. All eyes were of abnormal structure due to complications from prior intraocular surgeries and ocular trauma. Ocular complications observed included graft dislocations, high intraocular pressure（IOP）, IOL dislocations, macular edema and hyphema. Best corrected visual acuity（BCVA）, IOP and mean central endothelial cell density（ECD） were recorded.RESULTS： Thirteen eyes had a history of ocular trauma, 10 eyes had an anterior chamber IOL, 16 eyes had prior vitrectomy. The iris was abnormal in 22 cases. Graft dislocation occurred in 5（17.2%） of 29 eyes. IOL dislocation occurred in 2 eyes（6.9%）. High IOP was found in 9 eyes and was controlled with treatment. The preoperative mean BCVA was 20/286. The 6 mo postoperative mean BCVA was 20/42. The average center ECD was 1965.3 cells/mm^2 at 6 mo, and the rate of the donor cell loss was 34.7%.CONCLUSION： DSAEK combined with artisan aphakia IOL implantation is an alternative option for resolving endothelial and lens disorders in aphakic eyes without capsular support. However, it should be performed cautiously for eyes with severe iris defects.

Incidence of cystoid macular edema after Descemet's stripping automated endothelial keratoplasty

AIM： To determine the incidence of cystoid macular edema（CME） after Descemet＇s stripping automated endothelial keratoplasty（DSAEK）.METHODS： This study included all consecutive patients operated in a Spanish tertiary reference hospital over a period of four years. A total of 55 eyes from 47 patients matched the selection criteria. CME was diagnosed clinically at the slit-lamp and confirmed by optical coherence tomography. RESULTS： Six cases of CME were diagnosed postoperatively, which represented an incidence of 11%. Three patients had previously undergone DSAEK alone（7%; 3/41） and the other three, DSAEK combined with phacoemulsification（21%; 3/14）. Five out of six patients with CME responded to standard therapy.CONCLUSION： CME is a possible complication after DSAEK and can be treated with standard therapy. CME appears more frequently when DSAEK is combined with phacoemulsification and posterior chamber（PC） intraocular lens（IOL） implantation. Intraoperative damage to the corneal endothelial cells might play a role in the pathogenesis of CME. As long as the causes remain unclear, we recommend administering prophylaxis when risk factors are present or when combined surgery is planned.

Modified thin manual Descemet stripping endothelial keratoplasty with air-guided, non-pachymetric donor lenticule dissection: outcomes of graft thickness and complication rate

●AIM:To describe a modified technique of donor lenticule dissection for thin manual Descemet stripping endothelial keratoplasty(TM-DSEK).●METHODS:Donor material was soaked in balanced salt solution(BSS)for 30 min,before being mounted on an artificial anterior chamber(AAC).Rather than BSS,the AAC was filled with filtered air,resulting in a visible reflection at the corneal endothelium-air interface.This reflection served as a landmark for the depth of the dissection,facilitating the creation of a thin lenticule with low risk of perforation.Dissection was commenced at a standardized depth of 500 microns,with no initial pachymetry necessary.Totally 29 donor corneas were dissected by a novice TM-DSEK surgeon.Dissection time,central graft thickness at 2 mo and complications were analysed.●RESULTS:Results were similar to other endothelial keratoplasty techniques,despite the cases being performed by a novice DSEK surgeon.Mean dissection time was 7 min(range 6-10).One graft perforation occurred(3.45%),but the air tamponaded the break and enabled dissection to be restarted and completed from a different location.Mean central graft thickness after at least two months follow-up was 106 microns(range 25-170).●CONCLUSION:A problem with manual DSEK is the risk of graft perforation by attempting to dissect too thin a lenticule,or creating a thick graft due to fear of perforating.This modified air-guided technique addresses this problem,and is recommended for surgeons either embarking on the learning curve,or who wish to achieve more consistently thin grafts while reducing perforation rates.

Suturing Technique to Promote Graft Attachment in Challenging Cases of Descemet Stripping Endothelial Keratoplasty

Aims: To describe a technique that uses a transcorneal fixation suture for graft attachment in endothelial keratoplasty in high-risk for graft dislocation eyes. Materials and Methods: Case series included 12 eyes of 12 patients who underwent Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in the presence of high risk for graft dislocation factors. We describe a surgical technique that uses a transcorneal fixation suture to compress the donor graft onto the back surface of the recipient cornea. Outcome measures included intraoperative and postoperative complications, graft attachment and clarity and endothelial cell count at a 12 months follow-up period. Results: No intraoperative complications were noted and 11 grafts remained attached and clear with no suture related complications at a 12-month follow-up period. Partial peripheral graft detachment due to suture related graft folds, accompanied by mild corneal edema was noticed in one patient postoperatively. Reattachment and edema resolution occurred spontaneously after suture removal. The mean endothelial cell loss was 38.21% at 12 months. Conclusions: Temporary transcorneal fixation suture can be helpful in preventing graft detachment in eyes with high risk for graft dislocation.

A Novel Y-Suture Transfixation Technique to Improve Graft Adherence in High-Risk Descemets Stripping Automated Endothelial Keratoplasty

Purpose: To report a novel Y-suture transfixation technique to improve success rate of high-risk Descemets stripping automated endothelial keratoplasties (DSAEK). Design: Retrospective non-comparative case series. Participants: Twenty five high-risk patients undergoing DSAEK at one tertiary care institution. Methods: A retrospective evaluation of consecutively enrolled high-risk DSAEK cases performed by three surgeons at one institution during a 3-year period (2007-2010). Main outcome measures were graft adherence and suture-related complications. Results: Highrisk factors were defined as followed: prior incisional glaucoma surgery (58%), presence of vitreous in the anterior chamber (15%), anterior chamber intraocular lens (8%), graft dislocation (8%), previous DSAEK (8%), and iris trauma/aphakia (3%). Twenty-five high-risk patients underwent DSAEK with Y-suture transfixation. Postoperative follow-up ranged from 3 to 27 months. One patient had dislocation due to hypotony from prior trabeculectomy (4%), requiring repeat DSAEK. Neither primary graft failure nor suture-related complication was observed. Conclusion: The Y-suture transfixation technique is associated with improved success rate of high-risk DSAEK transplant.

Simultaneous tectonic Descemet stripping endothelial keratoplasty and tectonic Bowman layer transplant for the management of corneal perforation

AIM:To report the outcomes of three cases of corneal perforation managed with simultaneous tectonic Descemet stripping endothelial keratoplasty(t-DSEK)and tectonic Bowman layer transplant(t-BLT)as an alternative to tectonic penetrating keratoplasty(t-PKP).METHODS:Three eyes of three patients receiving simultaneous t-DSEK and t-BLT for corneal perforation were included.The technique for DSEK was modified depending on individual requirements.The t-BLT technique was standardised using an 8 mm graft and fixated with a running suture.Success was measured by the ability of this procedure to close a corneal perforation.RESULTS:All three cases achieved tectonic eye globe restoration and remained stable during the minimum 3-month observation period.Reinterventions were relatively common:2 cases required amniotic membrane transplant for persistent epithelial defects.One case required DSEK rebubbling.One case developed angle closure glaucoma requiring surgical peripheral iridectomy.CONCLUSION:Simultaneous t-DSEK and t-BLT may be a useful strategy for the management of corneal perforation as an alternative management to t-PKP for selected cases.

Destructive effects on endothelial cells of grafts in cytomegalovirus DNA-positive patients after keratoplasty

AIM:To investigate corneal graft survival rate and endothelial cell density(ECD)loss after keratoplasty in cytomegalovirus(CMV)positive patients.METHODS:This was a retrospective cohort study.We analyzed the clinical data of patients who underwent viral DNA detection in aqueous humor/corneal tissue collected during keratoplasty from March 2015 to December 2018 at the Peking University Third Hospital,Beijing,China.To further evaluate the effect of CMV on graft survival rate and ECD loss,patients were divided into three groups:1)CMV DNA positive(CMV+)group;2)viral DNA negative(virus-)group,comprising virus-group eyes pairwise matched to eyes in the CMV+group according to ocular comorbidities;3)control group,comprising virus-group eyes without ocular comorbidities.The follow-up indicators including graft survival rate,ECD,ECD loss,and central corneal thickness(CCT),were analyzed by Tukey honestly significant difference(HSD)test.RESULTS:Each group included 29 cases.The graft survival rate in CMV+group were lowest among the three groups(P=0.000).No significant difference in donor graft ECD was found among three groups(P=0.54).ECD in the CMV+group was lower than the virus-group at 12(P=0.009),and 24mo(P=0.002)after keratoplasties.Furthermore,ECD loss was higher in the CMV+group than in the virus-group in the middle stage(6-12mo)postkeratoplasty(P=0.017),and significantly higher in the early stage(0-6mo)in the virus-group than in the control group(P=0.000).CONCLUSION:CMV reduces the graft survival rate and exerts persistent detrimental effects on the ECD after keratoplasty.The graft ECD loss associate with CMV infection mainly occurrs in the middle stage(6-12mo postoperatively),while ocular comorbidities mainly affects ECD in the early stage(0-6mo postoperatively).

A 5-year analysis of endothelial vs penetrating keratoplasty graft survival in Chinese patients

AIM:To determine if there is any difference in longterm graft survival between Descemet’s stripping endothelial keratoplasty(DSEK)and penetrating keratoplasty(PK).METHODS:A retrospective 5-year cases analysis of bullous keratopathy secondary to Fuchs’endothelial dystrophy or pseudophakic bullous keratopathy,receiving either DSEK or PK.A total of 42 DSEK cases and 25 PK cases were included in the analysis.RESULTS:In the 5-year analysis,graft survival rates were very similar in the two groups(DSEK 77.1%vs PK76.0%.P=0.918.95%CI:-6.3 to 33.4).Sub-analyses at 1y(DSEK 81%vs PK 95%.P=0.085.95%CI:-29 to 3.6)and 2y(DSEK 81%vs PK 88%.P=0.381.95%CI:-25.9 to 11.8)show a trend towards lower survival rates of DSEK vs PK,but the results were not statistically significant.CONCLUSION:Longterm 5-year graft survival is similar between the DSEK and PK methods of corneal transplant in Chinese patients with bullous keratopathy.

Morphological Characteristics of the Endothelial Ceils of Corneas of Rabbits Preserved by Desiccation

The endothelial cells of the corneas of rabbits preserved by desiccation for vari-ous duration showed no hexagonal form of normal cells but broad bean-like nuclci afterdouble staining with alizarin red and trypan blue.Scanning electron microscopic examina-tion revealed interdigitation at the intercellular junction together with intercellularvacuoles and cellular edema.Transmission electron microscopic examination showedincomplete nuclear membrane,karyopyknosis,vacuoles and remnant organellae in thecytoplasm.Partial penetrating keratoplasties were done in 37 rabbits(37 eyes)with pre-served corneas.The grafts remained transparent for a minimum of 4 days to a maximumof over 1 year,and 7 grafts remained transparent for more than 30 days.Staining ofthe transparent grafts revealed normal hexagonal endothelial cells in mosaic arrange-ment.We assumed that after transplantation of the preserved cornea the endothelial cellsregained their activities owing to the nutrient effect of the aqueous humor.

深板层角膜移植与穿透性角膜移植治疗基质角膜营养不良预后的比较

背景:基质角膜营养不良的传统手术治疗方式为穿透性角膜移植,近年来越来越多的医生开始考虑使用深板层角膜移植治疗基质角膜营养不良。目前国内对比穿透性角膜移植和深板层角膜移植治疗基质角膜营养不良的研究少有报道。目的:比较深板层角膜移植和穿透性角膜移植治疗基质角膜营养不良的疗效。方法:选择2000年1月至2018年1月北部战区总医院收治的基质角膜营养不良患者57例(57眼),男18例,女39例,平均年龄(52.9±20.0)岁,按照手术治疗方式分为深板层角膜移植组(n=21)、穿性角膜移植组(n=36),术后随访观察最佳矫正视力、角膜内皮细胞密度、角膜植片透明度、术中及术后并发症、原病复发情况。结果与结论:①两组患者术后1,3,6,12个月的视力均高于术前(P<0.05),两组间术后不同时间点的视力比较差异无显著性意义(P>0.05);随着术后时间的延长,两组患者角膜内皮细胞密度逐渐降低,穿透性角膜移植组患者术后6,12个月的角膜内皮细胞密度年丢失率均高于深板层角膜移植组(P<0.05);两组患者术后12个月的角膜植片透明率比较差异无显著性意义(P>0.05);②深板层角膜移植组有6例出现并发症,穿透性角膜移植组有14例出现并发症,57例患者术后12个月内均无复发,两组患者术后5年的复发率比较差异无显著性意义(P>0.05),穿透性角膜移植组和深板层角膜移植组术后5年的移植物存活率分别为83%和86%,组间比较差异无显著性意义(P>0.05);③结果表明,基质角膜营养不良的治疗可考虑使用深板层角膜移植替代一部分穿透性角膜移植。

移植物厚度对角膜内皮失代偿行简易后弹力层角膜内皮移植效果的影响

背景:研究表明较薄移植物视力恢复更快、排斥风险更低,国内缺乏对内皮移植术后不同植片厚度的临床疗效分析,因此,确定最佳移植物厚度对于提高手术疗效至关重要。目的:评价简易后弹力层剥离内皮角膜移植术后不同植片厚度对视力恢复及其他预后指标的影响。方法:选取2013年1月至2023年2月在北部战区总医院接受简易后弹力层剥离内皮角膜移植手术治疗的角膜内皮失代偿患者共72例(72眼),其中薄植片组(<100μm)32例(32眼),厚植片组(≥100μm)40例(40眼)。随访1年,观察两组术前及术后1,3,6,12个月的最佳矫正视力,术后1年角膜内皮细胞数、角膜植片透明度、术后并发症、植片生存情况。结果与结论:①两组患者术后视力较术前均有显著提高,薄植片组患者术后3个月最佳矫正视力优于厚植片组(P<0.05);②两组术后1年角膜内皮细胞数及植片透明度比较差异无显著性意义(P>0.05);③两组患者继发性青光眼、植片免疫排斥、植片移位等术后并发症发生率比较差异无显著性意义(P>0.05);④两组术后1年植片生存率比较差异无显著性意义(93.8%,92.3%,P>0.05);⑤结论:简易后弹力层剥离内皮角膜移植术是一种安全有效的角膜内皮移植手术方式,其术后疗效与传统后弹力层剥离内皮角膜移植术相似,而且植片植入方式更为简便。较薄植片能够更早提供最佳矫正视力,更早完成角膜重塑,因此在治疗角膜内皮失代偿疾病时,优先选择薄移植物来提高恢复时间。

Indications for and techniques of keratoplasty at Vietnam National Institute of Ophthalmology

AIM： To report the indications for and techniques of corneal transplantation at Vietnam National Institute of Ophthalmology （VNIO） over a period of 12y （2002-2013）, METHODS： Records of patients who had undergone corneal transplantation at VNIO from January 1, 2002 to January 1, 2014 were reviewed to determine the indication for and type of corneal transplant performed. Patient age, gender, indication for corneal transplantation and surgical technique were recorded and analyzed. RESULTS： Corneal transplantation were underwent in 1390 eyes of 1278 patients with a mean age of 44.9±18.1y during the period under review. The most common indication was infectious corneal ulcer （n=670; 48.2%）, followed by corneal scar （n=333, 24.0% ）, corneal dystrophy （n=138, 9.9%） and failed graft （n=112, 8.1%）. Nearly all procedures performed were penetrating keratoplasty （n=1300, 93.5% ）, with a few lamellar keratoplasty procedures performed： lamellar keratoplasty （n=52, 3.7%）, Descemet＇s stripping automated endothelial keratoplasty （n =27, 1.9% ） and deep anterior lamellar keratoplasty （n =11, 0.8%）.CONCLUSION： While the most common indication for keratoplasty was infectious keratitis, nearly all indications for corneal transplantation were managed with penetrating keratoplasty, However, lamellar keratoplasty techniques, including deep anterior lamellar keratoplasty and Descemet＇s stripping automated endothelial keratoplasty, are being performed with increasing frequency for isolated stromal and endothelial disorders, respectively,

后弹力层角膜内皮移植术患者围手术期护理

目的总结后弹力层角膜内皮移植术(DMEK)患者围手术期护理经验。方法对18例(18眼)内皮功能失代偿患者实施DMEK,给予充分的围手术期护理及改善术后并发症的专科护理。结果18例患者手术顺利,住院时间6~12(8.17±1.82)d。14例在术后2 h出现高眼压,经放掉部分前房气体解除瞳孔阻滞,利用体位护理后眼压均下降;发生部分脱位5例(27.8%),通过再次前房注气后移植片均能完全复位。术后随访3个月,随访期间移植片在位,贴附良好,无排斥反应,无内皮功能失代偿,14例患者术后1个月矫正视力大于0.5,4例患者术后1个月矫正视力在0.2~0.5。结论对DMEK患者加强围手术期护理,重视术后体位控制以及对于高眼压的处理,对于确保手术效果至关重要。