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Descemet膜内皮角膜移植术的疗效:25例学习曲线后的连续200例临床结果

Efficacy of descemet membrane endothelial keratoplasty: clinical outcome of 200 consecutive cases after a learning curve of 25 cases.

作者信息

Dirisamer Martin, Ham Lisanne, Dapena Isabel, Moutsouris Kyros, Droutsas Konstantinos, van Dijk Korine, Frank Laurence E, Oellerich Silke, Melles Gerrit R J

机构信息

Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands.

出版信息

Arch Ophthalmol. 2011 Nov;129(11):1435-43. doi: 10.1001/archophthalmol.2011.195. Epub 2011 Jul 11.

DOI:10.1001/archophthalmol.2011.195
PMID:21746971
Abstract

OBJECTIVE

To evaluate Descemet membrane endothelial keratoplasty for management of corneal endothelial disorders.

METHODS

Descemet membrane endothelial keratoplasty was performed in 200 patients with Fuchs endothelial dystrophy or bullous keratopathy. Best-corrected visual acuity, subjective and objective refractive outcome and stability, and endothelial cell density were evaluated at 1, 3, and 6 months postoperatively, and intraoperative and postoperative complications were documented.

RESULTS

At 6 months, 94% reached a best-corrected visual acuity of 20/40 or better (≥0.5); 77%, 20/25 or better (≥0.8); 47%, 20/20 or better (≥1.0), and 16%, 20/17 or better (≥1.2) (n = 159). The preoperative to 6 months' postoperative spherical equivalent showed a mean (SD) +0.38 (1.2) diopter hyperopic shift (P = .001) that correlated with a decrease in central corneal thickness (n = 143) (P = .047). Two-thirds of eyes showed refractive stability at 3 months. Donor endothelial cell density showed a decrease from mean (SD) 2560 (186) cells/mm(2) preoperatively to 1690 (520) cells/mm(2) at 6 months after surgery (n = 173) (P < .001). Graft detachment was the main complication and occurred in 18 eyes (9%). Recipient Descemet membrane remnants were present in 12 eyes (6%). Secondary glaucoma was seen in 8 eyes (4%), of which 4 showed air-bubble dislocation behind the iris. In 2 of 33 phakic eyes (6%), a secondary cataract developed requiring phacoemulsification.

CONCLUSIONS

Descemet membrane endothelial keratoplasty may offer complete visual rehabilitation within 1 to 6 months after surgery in a majority of eyes. Similar to earlier keratoplasty techniques, Descemet membrane endothelial keratoplasty may be associated with a one-third decrease in donor endothelial cell density in the early postoperative phase. Incidence of (partial) graft detachment stabilized at about 5% but could be further reduced by patient selection and/or technique modification.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00521898.

摘要

目的

评估 Descemet 膜内皮角膜移植术治疗角膜内皮疾病的效果。

方法

对 200 例 Fuchs 内皮营养不良或大泡性角膜病变患者施行 Descemet 膜内皮角膜移植术。在术后 1、3 和 6 个月评估最佳矫正视力、主观和客观屈光结果及稳定性,以及内皮细胞密度,并记录术中及术后并发症。

结果

术后 6 个月时,94%的患者最佳矫正视力达到 20/40 或更好(≥0.5);77%达到 20/25 或更好(≥0.8);47%达到 20/20 或更好(≥1.0),16%达到 20/17 或更好(≥1.2)(n = 159)。术前至术后 6 个月的等效球镜度平均(标准差)显示有 +0.38(1.2)屈光度的远视漂移(P = 0.001),这与中央角膜厚度的减少相关(n = 143)(P = 0.047)。三分之二的患眼在术后 3 个月屈光稳定。供体内皮细胞密度从术前平均(标准差)2560(186)个细胞/mm²降至术后 6 个月时的 1690(520)个细胞/mm²(n = 173)(P < 0.001)。植片脱离是主要并发症,发生在 18 只眼(9%)。12 只眼(6%)存在受体 Descemet 膜残余。8 只眼(4%)出现继发性青光眼,其中 4 只眼虹膜后有气泡移位。在 33 只晶状体眼中有 2 只眼(6%)发生继发性白内障,需要行超声乳化术。

结论

Descemet 膜内皮角膜移植术可使大多数患眼在术后 1 至 6 个月内实现完全视力恢复。与早期角膜移植技术类似,Descemet 膜内皮角膜移植术在术后早期供体内皮细胞密度可能会降低三分之一。(部分)植片脱离的发生率稳定在约 5%,但可通过患者选择和/或技术改进进一步降低。

试验注册

clinicaltrials.gov 标识符:NCT00521898 。

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