[Descemet膜内皮角膜移植术（DMEK）后的视力：首批100例因Fuchs内皮营养不良接受手术的病例]
[Visual acuity following Descemet-membrane endothelial keratoplasty (DMEK): first 100 cases operated on for Fuchs endothelial dystrophy].
作者信息
Droutsas K, Ham L, Dapena I, Geerling G, Oellerich S, Melles G
机构信息
NIIOS, Niederländisches Institut für Innovative Augenchirurgie, Rotterdam.
出版信息
Klin Monbl Augenheilkd. 2010 Jun;227(6):467-77. doi: 10.1055/s-0029-1245446. Epub 2010 Jun 17.
PURPOSE
The aim of this study was to evaluate the visual outcome and endothelial cell density in the first series of 100 eyes after Descemet membrane endothelial keratoplasty (DMEK) for the treatment of Fuchs endothelial dystrophy.
DESIGN
This was a non-randomised prospective clinical trial.
METHODS
The first 100 consecutive eyes (87 patients) that underwent DMEK (i. e., transplantation of an isolated donor Descemet membrane carrying its endothelium) for Fuchs endothelial dystrophy were evaluated. In all eyes, the best corrected visual acuity (BCVA) as well as the endothelial cell density (ECD) were measured before and at one, three and six months after surgery.
RESULTS
In eyes with a functional DMEK graft and good visual potential (n = 78), the BCVA was > or = 20 / 40 (> or = 0.5) in 79 % after 1 month, 94 % after 3 months, and 96 % after six months; > or = 20 / 25 (> or = 0.8) in respectively 54 %, 64 %, and 74 %, and > or = 20 / 20 (> or = 1.0) in respectively 26 %, 36 %, and 45 %. In this group, ECD averaged 2630 (+/- 190) cells/mm (2) before, and 1800 (+/- 540) cells/mm (2) at six months after surgery (n = 76). In 15 eyes, a secondary "Descemet stripping endothelial keratoplasty" (DSEK) was performed. When the outcomes of DMEK and secondary DSEK procedures were combined, 91 % reached a BCVA of > or = 20 / 40 (> or = 0.5), 65 % > or = 20 / 25 (> or = 0.8) and 38 % > or = 20 / 25 (> or = 1.0) at six months after surgery (n = 93). For the whole group, ECD averaged 2620 (+/- 190) cells/mm (2) before, and 1730 (+/- 590) cells/mm (2) at six months after surgery (n = 89).
CONCLUSION
DMEK may provide relatively quick and nearly complete visual rehabilitation in a majority of patients operated on for Fuchs endothelial dystrophy. Endothelial cell survival may be similar to earlier types of endothelial keratoplasty. Early graft detachment (19 cases) was the main complication in this first series of DMEK surgeries.
目的
本研究旨在评估100例接受Descemet膜内皮角膜移植术（DMEK）治疗Fuchs内皮营养不良的患者的首批病例的视觉效果和内皮细胞密度。
设计
这是一项非随机前瞻性临床试验。
方法
对首批连续100例（87例患者）因Fuchs内皮营养不良接受DMEK（即移植带有内皮的孤立供体Descemet膜）的患者进行评估。所有患者均在手术前、术后1个月、3个月和6个月测量最佳矫正视力（BCVA）和内皮细胞密度（ECD）。
结果
在DMEK移植功能良好且视觉潜力佳的患者眼中（n = 78），术后1个月时，79%的患者BCVA≥20/40（≥0.5），3个月时为94%，6个月时为96%；分别有54%、64%和74%的患者BCVA≥20/25（≥0.8），分别有26%、36%和45%的患者BCVA≥20/20（≥1.0）。该组患者术前ECD平均为2630（±190）个细胞/mm²，术后6个月为1800（±540）个细胞/mm²（n = 76）。15只眼睛进行了二次“Descemet膜剥除内皮角膜移植术”（DSEK）。将DMEK和二次DSEK手术的结果合并后，术后6个月时，91%的患者BCVA≥20/40（≥0.5），65%的患者≥20/25（≥0.8），38%的患者≥20/20（≥1.0）（n = 93）。对于整个组，术前ECD平均为2620（±190）个细胞/mm²，术后6个月为1730（±590）个细胞/mm²（n = 89）。
结论
对于大多数接受Fuchs内皮营养不良手术的患者，DMEK可能提供相对快速且近乎完全的视力恢复。内皮细胞存活率可能与早期的内皮角膜移植术相似。早期移植片脱离（19例）是这首批DMEK手术中的主要并发症。
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