角膜内皮移植・白内障同時手術と二期的手術の比較

Comparison of cataract surgery and Descemet stripping automated endothelial keratoplasty in one and separate sessions

要約　目的：角膜内皮移植（DSAEK）と白内障手術を施行した症例において，同時手術および二期的手術の成績を比較する。

対象と方法：当院で2009〜2014年に水疱性角膜症に対しDSAEK，白内障手術を同時，または二期的に施行した56例62眼。術後矯正視力，角膜内皮細胞密度，術後合併症につき後ろ向きに検討を行った。

結果：Fuchs角膜内皮変性症（FED）症例では同時手術群，二期的手術群の術後経過に差はみられなかったが，FED以外の症例では二期的手術群のほうが術後視力が良く，primary graft failureの頻度が低かった。

結論：FED以外の水疱性角膜症症例では二期的手術のほうが経過良好であった。

Abstract　Purpose: To report and compare the outcome of cataract surgery and Descemet stripping automated endothelial keratoplasty（DSAEK）in one and separate sessions.

Case and Method: This retrospective study was made on 62 eyes of 56 cases who received cataract surgery and DSAEK in the past 6 years. The series comprised 24 males and 38 females. The age ranged from 47 to 88 years and averaged 88 years. There were 15 eyes of Fuchs endothelial dystrophy. Laser iridotomy was the most frequent cause of corneal endothelial lesion in the other cases. Cataract surgery and DSAEK were performed in one session in 21 eyes and in separate session in 41 eyes.

Results: There was no difference in the outcome in eyes with Fuchs endothelial dystrophy whether the treatment was performed in one or separate sessions. Postoperative visual acuity as well as primary graft failure was better in the other group that received cataract surgery and DSAEK in separate sessions.

Conclusion: Outcome of cataract surgery and DSAEK was better when performed in separate sessions for bullous keratopathy except Fuchs endothelial dystrophy.