van der Meulen Ivanka J E, Patel Sanjay V, Lapid-Gortzak Ruth, Nieuwendaal Carla P, McLaren Jay W, van den Berg Thomas J T P
Department of Ophthalmology, A2 Room 123.1, Academic Medical Center, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands.
Arch Ophthalmol. 2011 Dec;129(12):1537-42. doi: 10.1001/archophthalmol.2011.247. Epub 2011 Aug 8.
To evaluate the quality of vision (visual acuity and straylight) in patients with Fuchs dystrophy and the improvement in visual quality after Descemet stripping endothelial keratoplasty (DSEK).
There was an observational case series (Amsterdam group) and a prospective interventional case series (Mayo group). Corrected distance visual acuity (CDVA), straylight, and corneal thickness were measured in patients with phakic and pseudophakic eyes with Fuchs dystrophy recruited at the Academic Medical Center, Amsterdam, the Netherlands (99 eyes), and at Mayo Clinic, Rochester, Minnesota (48 eyes). The Mayo group was also examined at 1, 3, 6, and 12 months after DSEK; all these eyes were rendered pseudophakic during DSEK.
Eyes with Fuchs dystrophy had decreased CDVA (mean [SD], 0.42 [0.26] logMAR; Snellen equivalent 20/53) and increased straylight (mean [SD], 1.54 [0.24] logarithm of the straylight parameter) compared with normal eyes. Younger patients were affected more by increased straylight than by decreased CDVA. Corrected distance visual acuity (r = 0.26; P = .003; n = 135) and straylight (r = 0.26; P = .003; n = 133) were correlated with corneal thickness. Corrected distance visual acuity and straylight improved at all postoperative examinations (P < .001), and improvement in straylight from before DSEK to 12 months after DSEK correlated with recipient age (r = -0.43; P = .01; n = 33). Improvement in straylight was more predictable than that of CDVA and was associated with preoperative straylight more than 1.33 logarithm of the straylight parameter.
Quality of vision is severely impaired in patients with Fuchs dystrophy and improves significantly after DSEK. Straylight improves more in younger than in older eyes after DSEK. Preoperative straylight can be a useful clinical metric to predict postoperative improvement, especially in cases where preoperative visual acuity is close to 20/20.
评估富克斯角膜内皮营养不良患者的视力质量（视力和散射光）以及后弹力层剥除内皮角膜移植术（DSEK）后视觉质量的改善情况。
有一个观察性病例系列（阿姆斯特丹组）和一个前瞻性干预性病例系列（梅奥组）。在荷兰阿姆斯特丹学术医疗中心（99只眼）和美国明尼苏达州罗切斯特市梅奥诊所（48只眼）招募的有晶状体和无晶状体的富克斯角膜内皮营养不良患者中，测量矫正远视力（CDVA）、散射光和角膜厚度。梅奥组在DSEK术后1、3、6和12个月也进行了检查；所有这些眼睛在DSEK期间均变为无晶状体眼。
与正常眼睛相比，富克斯角膜内皮营养不良患者的眼睛CDVA降低（平均值[标准差]，0.42[0.26]logMAR；Snellen等效值20/53），散射光增加（平均值[标准差]，1.54[0.24]散射光参数对数）。年轻患者受散射光增加的影响比CDVA降低的影响更大。矫正远视力（r = 0.26；P = 0.003；n = 135）和散射光（r = 0.26；P = 0.003；n = 133）与角膜厚度相关。所有术后检查中矫正远视力和散射光均有所改善（P < 0.001），并且从DSEK术前到术后12个月散射光的改善与受者年龄相关（r = -0.43；P = 0.01；n = 33）。散射光的改善比CDVA更可预测，并且与术前散射光大于1.33散射光参数对数的相关性更强。
富克斯角膜内皮营养不良患者的视觉质量严重受损，DSEK后显著改善。DSEK后，年轻眼睛的散射光改善比老年眼睛更多。术前散射光可作为预测术后改善的有用临床指标，尤其是在术前视力接近20/20的情况下。
