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角膜内皮移植术后视觉质量的影响因素

Turnbull AM, Tsatsos M, Hossain PN, et al.

期刊名称:Survey of Ophthalmology

卷期:2016年第61卷第3期

关键词:
内皮 角膜 视觉

摘要

角膜内皮移植术多用于全层角膜移植治疗继发于血管内皮功能障碍的角膜失代偿。虽然随着医生努力改善预后,角膜内皮移植术已发生变化,但很少有患者达到预期的最佳矫正视力20/20,尽管采用了健康移植物且无眼合并症。这种情况的原因尚不清楚,相关理论包括前基质变化,移植厚度和均匀性差异,诱发高阶像差,与移植物-宿主接触面特点。较新的角膜内皮移植术迭代如薄手动弹力剥离角膜内皮移植术,超薄自动化弹力剥离角膜内皮移植术,和弹力膜内皮角膜移植已使近50%的患者实现20/20视力,与现代白内障手术率相当,但可能存在天花板(瓶颈),特别是老龄组患者。确定决定角膜内皮移植术后视觉质量的因素的相对贡献将有助于推动进一步的创新,优化视觉和患者病人报告预后,同时提高手术疗效和安全性。

Endothelial keratoplasty is now favored over full-thickness penetrating keratoplasty for corneal decompensation secondary to endothelial dysfunction. Although endothelial keratoplasty has evolved as surgeons strive to improve outcomes, fewer patients than expected achieve best corrected visual acuity of 20/20 despite healthy grafts and no ocular comorbidities. Reasons for this remain unclear, with theories including anterior stromal changes, differences in graft thickness and regularity, induced high-order aberrations, and the nature of the graft-host interface. Newer iterations of endothelial keratoplasty such as thin manual Descemet stripping endothelial keratoplasty, ultrathin automated Descemet stripping endothelial keratoplasty, and Descemet membrane endothelial keratoplasty have achieved rates of 20/20 acuity of approximately 50%, comparable to modern cataract surgery, and it may be that a ceiling exists, particularly in the older age group of patients. Establishing the relative contribution of the factors that determine visual quality following endothelial keratoplasty will help drive further innovation, optimizing visual and patient-reported outcomes while improving surgical efficacy and safety.


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