Ham Lisanne, Balachandran Chandra, Verschoor Christianne A, van der Wees Jacqueline, Melles Gerrit R J
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.
Arch Ophthalmol. 2009 Mar;127(3):252-5. doi: 10.1001/archophthalmol.2008.619.
To evaluate visual rehabilitation after Descemet membrane endothelial keratoplasty (DMEK) in the management of corneal endothelial disorders.
In this prospective, nonrandomized, clinical study, DMEK was performed in a first group of 35 consecutive patients with either Fuchs endothelial dystrophy or bullous keratopathy. The Descemet membrane was stripped from the recipient posterior stroma with the anterior chamber completely filled with air. Using a 3.0-mm clear corneal incision, an organ-cultured donor Descemet roll 9 to 10 mm in diameter was inserted into the recipient anterior chamber, positioned on the posterior stroma, and secured by completely filling the anterior chamber with air for 45 to 60 minutes.
Ten eyes had preexisting ocular disease or an early graft detachment. In the remaining 25 DMEK-treated eyes, best-corrected visual acuity was 20/40 (Snellen notation, 0.5) or more in 18 eyes (72%) within 1 month. At 3 months, best-corrected visual acuity was 20/40 (0.5) or more in 23 of 25 eyes (92%) and 20/25 (0.8) or more in 15 of 25 eyes (60%).
In most cases, DMEK results in functional visual rehabilitation within 1 to 3 months. Overall, visual recovery after DMEK may be faster and more complete than with other techniques for (lamellar) keratoplasty for treatment of corneal endothelial disorders.
clinicaltrials.gov Identifier: NCT00521898.
评估在角膜内皮疾病治疗中，后弹力层内皮角膜移植术（DMEK）后的视力恢复情况。
在这项前瞻性、非随机的临床研究中，连续35例患有Fuchs内皮营养不良或大疱性角膜病变的患者被纳入第一组并接受DMEK手术。在前房完全充满空气的情况下，从受体后基质层剥离后弹力层。通过一个3.0毫米的透明角膜切口，将直径9至10毫米的器官培养供体后弹力层卷插入受体前房，放置在后基质层上，并通过向前房完全充满空气45至60分钟来固定。
10只眼存在既往眼部疾病或早期移植片脱离。在其余25只接受DMEK治疗的眼中，18只眼（72%）在1个月内最佳矫正视力达到20/40（Snellen视力表，0.5）或更好。在3个月时，25只眼中的23只眼（92%）最佳矫正视力达到20/40（0.5）或更好，25只眼中的15只眼（60%）最佳矫正视力达到20/25（0.8）或更好。
在大多数情况下，DMEK可在1至3个月内实现功能性视力恢复。总体而言，DMEK术后的视力恢复可能比用于治疗角膜内皮疾病的其他（板层）角膜移植技术更快、更完全。
clinicaltrials.gov标识符：NCT00521898。
