Department of Ophthalmology, University of Erlangen-Nuremberg, Erlangen, Germany.
Am J Ophthalmol. 2012 Jun;153(6):1082-90.e2. doi: 10.1016/j.ajo.2011.12.012. Epub 2012 Mar 6.
To evaluate visual outcome and endothelial cell survival after Descemet membrane endothelial keratoplasty (DMEK) in comparison with Descemet stripping automated endothelial keratoplasty (DSAEK).
Single-center, retrospective, consecutive case series.
Thirty-eight eyes of 38 consecutive patients undergoing DMEK, who completed a 6-month follow-up, were compared with 35 eyes of 35 consecutive patients undergoing DSAEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy. Main outcome measures included best-corrected visual acuity (in logarithm of the minimal angle of resolution [logMAR] units) and endothelial cell density within a 6-month follow-up.
Best-corrected visual acuity increased from 0.70 ± 0.48 logMAR and 0.75 ± 0.32 logMAR before surgery to 0.21 ± 0.14 logMAR and 0.48 ± 0.19 logMAR 3 months after DMEK and DSAEK (P < .001), respectively, and to 0.17 ± 0.12 logMAR and 0.36 ± 0.15 logMAR 6 months after DMEK and DSAEK (P < .001), respectively. Endothelial cell density decreased from 2575 ± 260 cells/mm(2) and 2502 ± 220 cells/mm(2) before surgery to 1498 ± 244 cells/mm(2) and 1778 ± 420 cells/mm(2) 3 months after DMEK and DSAEK (P < .001), respectively, and to 1520 ± 299 cells/mm(2) and 1532 ± 495 cells/mm(2) 6 months after DMEK and DSAEK (P = .483), respectively. Central corneal thickness decreased from 652 ± 92 μm before surgery to 517 ± 45 μm 6 months after DMEK, and from 698 ± 137 μm before surgery to 618 ± 66 μm 6 months after DSAEK.
DMEK provided faster and more complete visual rehabilitation when compared with DSAEK. However, there were no significant differences concerning endothelial cell survival within a 6-month follow-up.
比较经 Descemet 膜内皮角膜移植术（DMEK）与 Descemet 撕囊自动角膜内皮移植术（DSAEK）治疗后，视觉结果和内皮细胞存活率的差异。
单中心回顾性连续病例系列研究。
对 38 只眼（38 例连续患者）行 DMEK 手术并完成 6 个月随访，与 35 只眼（35 例连续患者）行 DSAEK 手术治疗 Fuchs 内皮营养不良或后发性白内障性大泡性角膜病变进行比较。主要观察指标包括最佳矫正视力（以最小分辨角对数[logMAR]单位表示）和术后 6 个月内的内皮细胞密度。
DMEK 和 DSAEK 术后 3 个月最佳矫正视力分别从术前的 0.70±0.48 logMAR 和 0.75±0.32 logMAR 增加到 0.21±0.14 logMAR 和 0.48±0.19 logMAR（P<0.001），术后 6 个月分别增加到 0.17±0.12 logMAR 和 0.36±0.15 logMAR（P<0.001）。DMEK 和 DSAEK 术后 3 个月内皮细胞密度分别从术前的 2575±260 个/mm²和 2502±220 个/mm²下降到 1498±244 个/mm²和 1778±420 个/mm²（P<0.001），术后 6 个月分别下降到 1520±299 个/mm²和 1532±495 个/mm²（P=0.483）。中央角膜厚度在 DMEK 术后 6 个月时从术前的 652±92 μm 下降到 517±45 μm，在 DSAEK 术后 6 个月时从术前的 698±137 μm 下降到 618±66 μm。
与 DSAEK 相比，DMEK 可更快更完全地恢复视力。但在术后 6 个月的随访中，内皮细胞存活率没有显著差异。
