데스메막박리자동각막내피이식 후 각막내피세포 밀도에 영향을 주는 인자 분석
Factors Influencing Corneal Endothelial Cell Density after Descemet Stripping Automated Endothelial Keratoplasty
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목적: 데스메막박리자동내피각막이식 12개월 후 각막내피세포 밀도를 결정하는 인자들이 무엇인지 알아보고자 한다. 대상과 방법: 본 연구는 2021년 3월부터 2022년 3월까지 해외기증각막을 통해 데스메막박리자동내피각막이식을 시행받은 수포각막병증 환자들을 대상으로 하였다. 수술 전 수여자의 인자들(나이, 수포각막병증의 원인, 안압, 시력, 전방부피, 전방각, 전방깊이, 동공 크기, 각막윤부직경, 수술 전 각막내피세포 밀도 등)과 기증자의 인자들(나이, 사후 안구보존까지의 시간, 안구보존 후 각막이식까지의 시간, 사후 각막이식까지의 시간, 각막내피세포 밀도, 원형 절제[trephine) 크기, 미리 절개된 조직[precut) 두께)을 측정하였다. 이를 통해 각막이식 후 12개월까지의 각막내피세포 밀도와 연관된 요인을 분석하였다. 결과: 본 연구는 53명의 환자가 참여하였으며, 수술 전 수여자의 평균 나이는 65.9 ± 14.6세였다. 기증자의 평균 각막내피세포 밀도는 2,871.6 ± 271.6 cells/mm2로 측정되었다. 수술 후 6개월과 12개월에는 각각 기증각막의 각막내피세포 밀도 대비 각각 36.9%, 47.2%로 각막내피세포 밀도가 감소하였다. 다변량 선형 회귀분석 결과, 수술 후 3달째와 12달째 각막내피세포 밀도는 수여자의 나이와 전방 깊이가 연관이 있었다. 결론: 데스메막박리자동내피각막이식 후 12개월 동안의 각막내피세포 밀도는 초기 손실 후 안정화되는 경향을 보이며, 수여자의 나이가 많을수록, 전방깊이가 얕을수록 높은 각막내피세포 밀도를 보인다.
Abstract
Purpose: To identify determinants of corneal endothelial cell density at 12 months after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: This study included patients with bullous keratopathy who underwent DSAEK with internationally sourced donor corneas from March 2021 to March 2022. We assessed various preoperative factors in recipients (age, cause of bullous keratopathy, intraocular pressure, visual acuity, anterior chamber volume, depth and angle, pupil size, white-to-white corneal diameter, and preoperative corneal endothelial cell density) and donors (age, death to preservation time, preservation to transplantation time, death to transplantation time, corneal endothelial cell density, trephine size, and precut tissue thickness). We analyzed factors influencing corneal endothelial cell density up to 12 months after keratoplasty. Results: This study involved 53 patients, with an average recipient age of 65.9 ± 14.6 years prior to surgery. Donor corneas had an average endothelial cell density of 2,871.6 ± 271.6 cells/mm2. At 6 and 12 months postoperatively, endothelial cell densities had decreased by 36.9% and 47.2%, respectively, compared with preoperative levels. Multivariate linear regression analysis indicated that endothelial cell densities at 3 and 12 months postoperatively were linked to recipient age and anterior chamber depth. Conclusions: Corneal endothelial cell density after DSAEK typically stabilized after initial decline; higher densities were found in older recipients and individuals with shallower anterior chambers.
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