نشانه ها، مشخصات بالینی و نتایج جراحی در پیوند اندوتلیال قرنیه
Abstract
Introduction
Materials and methods
Results
Discussion
Conclusion
References
Abstract
Background: Endothelial keratoplasties have become the surgical procedure of choice over full thickness penetrating keratoplasty for corneal decompensation because of endothelial dysfunction. Methods: A retrospective data review was performed from February 2016 to April 2017 for all the patients who underwent endothelial keratoplasty in a tertiary care center for Indian Armed Forces. Results: A total of 161 corneal transplants were performed; endothelial keratoplasties accounted for 34 (21.1%) transplants. Most common indication was pseudophakic/ aphakic bullous keratopathy followed by Ahmed glaucoma valveerelated corneal decompensation and Fuchs' corneal dystrophy, respectively. Mean preoperative corneal thickness was 845.96 ± 106.9 microns. Mean lenticule thickness was 131.55 ± 42.47 microns with microkeratome for descemet stripping automated endothelial keratoplasty (DSAEK) and 174 ± 70.4 microns manually for descemet stripping endothelial keratoplasty (DSEK). Mean preoperative best-corrected visual acuity (BCVA) was 1.65 LogMAR (Snellen equivalent in meters 2/60 approx) which significantly improved to 0.82 LogMAR (Snellen equivalent in meters 6/36 approx) after surgery. In the DSAEK group, BCVA improved from 1.61 to 0.7 LogMAR, whereas in the DSEK group, the visual acuity improved from 1.7 to 0.94 LogMAR at one-month postoperative period. Postoperatively, two patients had graft detachment and had to undergo repeat DSAEK.
Introduction
Lamellar keratoplasty has emerged as an alternative to full thickness penetrating keratoplasty (PKP) in recent years because of technological advancements in corneal imaging and newer surgical equipment and are guided by the location of corneal pathology.1 Diseases involving corneal endothelium can now be managed by selective replacement of the affected part by newer endothelial keratoplasty procedures such as descemet stripping automatedeendothelial keratoplasty (DSAEK), descemet stripping endothelial keratoplasty (DSEK), or descemet membrane endothelial keratoplasty (DMEK). In most tertiary eye care centers around the world, more and more lamellar keratoplasties are being performed than PKP because of advantages of early visual rehabilitation, less graft rejection, less surgically induced astigmatism, and better patient comfort.2e6 Endothelial keratoplasties, i.e., DSAEK, DSEK, and DMEK are being increasingly performed in our center for endothelial dysfunction, but no published data about indications, clinical profile, or surgical outcomes of endothelial keratoplasties are available in our setup. We describe the indications, donor lenticule characteristics, and surgical outcomes of endothelial keratoplasties among Armed Forces personnel and their relatives and compare these characteristics with the various studies published in the literature.