Cornea Research Foundation of America, Indianapolis, Indiana 46260, USA.
Ophthalmology. 2011 Dec;118(12):2368-73. doi: 10.1016/j.ophtha.2011.06.002. Epub 2011 Aug 27.
To report 1-year outcomes of Descemet's membrane endothelial keratoplasty (DMEK) performed at 2 centers.
Prospective, consecutive, interventional series.
Patients with Fuchs' endothelial dystrophy, pseudophakic bullous keratoplasty, or failed previous graft (n = 136 eyes).
The diseased central 7 mm of Descemet's membrane (DM) was stripped from the recipient cornea and replaced with healthy DM and endothelium stripped from donor corneas through a 2.8-mm corneal incision. Descemet's membrane endothelial keratoplasty was performed alone (n = 110) or combined with either phacoemulsification and intraocular lens implantation (n = 23) or pars plana vitrectomy (n = 3).
Best spectacle-corrected visual acuity (BSCVA), manifest refraction, and endothelial cell density.
Excluding eyes with pre-existing ocular comorbidities or those lost to follow-up, mean BSCVA at 1 year was 0.07 logarithm minimum angle of resolution (logMAR) units (20/24; range, 20/15-20/40; n = 81), improving from 0.51 logMAR (20/65; range, 20/20-counting fingers); 41% of the patients achieved a BSCVA of 20/20 or better, 80% could be corrected to 20/25 or better, and 98% achieved 20/30 or better vision. A refractive hyperopic shift of +0.24 ± 1.01 diopters (D; range, -1.50 to 2.25 D) was found at 1 year, but it was not statistically significant (P = 0.08). Also, there was no significant change in the preoperative astigmatism (P = 0.17). The endothelial cell loss at 1 year was 36 ± 20% (n = 94; range, 13%-88%), with most of the loss being observed during the first 3 months after surgery: 31 ± 18% (range, 3%-77%). The DMEK graft creation could not be successfully completed in 6 cases (4.2%). All these unsuccessful attempts were among the initial 40 cases. Intracameral air was used to fix graft detachments, which usually were partial and peripheral, in 62% of the cases. Eleven grafts (8%) demonstrated primary failure and 1 eye (0.7%) had secondary failure resulting from endothelial rejection. Episodes of immunologic rejection were documented in 7 eyes (5.1%) during the first year of follow-up.
Descemet's membrane endothelial keratoplasty had better visual acuity results in the first year after surgery than typically reported for other endothelial keratoplasty techniques, such as Descemet's stripping automated endothelial keratoplasty, while having less refractive changes and similar endothelial cell counts but a higher rebubbling rate.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
报告在 2 个中心进行的 Descemet 膜内皮角膜移植术（DMEK）的 1 年结果。
前瞻性、连续、干预性系列研究。
患有 Fuchs 内皮营养不良、假性囊泡性角膜病变或先前移植失败的患者（n = 136 只眼）。
从供体角膜上剥离病变的中央 7 毫米 Descemet 膜（DM），并用健康的 DM 和内皮细胞替换受体角膜，通过 2.8 毫米的角膜切口。DMEK 单独进行（n = 110）或与超声乳化白内障吸除术和人工晶状体植入术（n = 23）或玻璃体切除术（n = 3）联合进行。
最佳矫正视力（BSCVA）、显性折射和内皮细胞密度。
排除有预先存在的眼部合并症或失访的眼，1 年后平均 BSCVA 为 0.07 对数最小角分辨率（logMAR）单位（20/24；范围，20/15-20/40；n = 81），从 0.51 logMAR（20/65；范围，20/20-计数手指）提高；41%的患者达到 20/20 或更好的视力，80%的患者可以矫正到 20/25 或更好，98%的患者达到 20/30 或更好的视力。1 年后发现远视屈光性移位+0.24 ± 1.01 屈光度（D；范围，-1.50 至 2.25 D），但无统计学意义（P = 0.08）。术前散光也没有明显变化（P = 0.17）。1 年后内皮细胞丢失 36 ± 20%（n = 94；范围，13%-88%），大多数丢失发生在手术后的前 3 个月：31 ± 18%（范围，3%-77%）。在 6 例（4.2%）中无法成功完成 DMEK 移植物的创建。所有这些不成功的尝试都发生在最初的 40 例中。在 62%的病例中，使用眼内空气固定移植物脱离，通常是部分和周边的。11 个移植物（8%）出现原发性失败，1 只眼（0.7%）因内皮排斥而出现继发性失败。在 1 年的随访期间，7 只眼（5.1%）出现免疫排斥发作。
与其他内皮角膜移植术技术（如 Descemet 膜撕脱自动化内皮角膜移植术）相比，DMEK 在术后 1 年内获得了更好的视力结果，而折射变化更小，内皮细胞计数相似，但复发性气泡形成率更高。
作者在本文讨论的任何材料中均没有专有的或商业的利益。
