Price Vision Group, Indianapolis, Indiana; Cornea Research Foundation of America, Indianapolis, Indiana.
Price Vision Group, Indianapolis, Indiana.
Ophthalmology. 2014 Feb;121(2):454-8. doi: 10.1016/j.ophtha.2013.09.032. Epub 2013 Nov 16.
To compare the outcomes of triple Descemet's membrane endothelial keratoplasty (DMEK) versus DMEK alone in pseudophakic eyes.
Retrospective, comparative, interventional case series.
Patients with Fuchs' endothelial dystrophy, secondary corneal edema, and prior failed endothelial keratoplasty with or without prior cataract extraction.
Outcomes of 492 DMEK procedures performed between April 2010 and August 2012 were reviewed; 292 pseudophakic eyes underwent DMEK (group 1) and 200 eyes had concurrent cataract surgery with DMEK (group 2).
Corrected distance visual acuity, endothelial cell loss, immediate and early postoperative complications.
The mean age at the time of surgery was 70 years (range, 47-94 years) in group 1 and 64 years (range, 46-90 years) in group 2 (P <0.0001). At 6 months, the median corrected distance visual acuity was 20/25 (range, 20/16-20/80; n = 164) in group 1 and 20/20 (range, 20/16-20/100; n = 121) in group 2 (P <0.0001), excluding 21 eyes with retinal or optic nerve problems. The DMEK graft failed to clear in 9 eyes (3.1%) in group 1 and 7 eyes (3.5%) in group 2 (P = 0.34); all were regrafted successfully with DMEK. No further graft failures occurred during the follow-up period. The air reinjection rate was 30% in group 1 and 29% in group 2 (P = 0.69). The air reinjection rate dropped significantly in both groups, from 45% to 16%, after use of viscoelastic was eliminated during the tissue insertion step. The median endothelial cell loss at 3 to 6 months did not differ significantly between groups (26% in both).
Triple DMEK was not associated with any higher risk of complications than DMEK alone. Compared with sequential management of patients with concomitant cataract and endothelial dysfunction, triple DMEK is an effective strategy in rapid visual rehabilitation and offers the advantage of a 1-stage procedure, with reduced risks and costs.
比较白内障术后三联式 Descemet 膜内皮角膜移植术（DMEK）与单纯 DMEK 的效果。
回顾性、对比、干预性病例系列研究。
患有 Fuchs 角膜内皮营养不良、继发性角膜水肿和既往失败的内皮角膜移植术，且伴有或不伴有白内障摘除术的患者。
回顾 2010 年 4 月至 2012 年 8 月间进行的 492 例 DMEK 手术的结果；292 只白内障术后眼行 DMEK（第 1 组），200 只眼同期行白内障摘除术联合 DMEK（第 2 组）。
矫正视力、内皮细胞丢失、即刻和早期术后并发症。
第 1 组的平均手术年龄为 70 岁（范围，47-94 岁），第 2 组为 64 岁（范围，46-90 岁）（P<0.0001）。6 个月时，第 1 组 164 只眼的最佳矫正视力为 20/25（范围，20/16-20/80），第 2 组 121 只眼为 20/20（范围，20/16-20/100）（P<0.0001），排除 21 只视网膜或视神经有问题的眼。第 1 组有 9 只眼（3.1%）和第 2 组有 7 只眼（3.5%）的 DMEK 移植物未清除（P=0.34），均用 DMEK 成功再次移植。随访期间未再发生移植物失败。第 1 组空气再注入率为 30%，第 2 组为 29%（P=0.69）。两组在组织插入步骤中停止使用黏弹剂后，空气再注入率均显著下降，从 45%降至 16%。3 至 6 个月时，两组间内皮细胞丢失中位数无显著差异（均为 26%）。
三联式 DMEK 并不比单纯 DMEK 有更高的并发症风险。与白内障合并内皮功能障碍患者的序贯治疗相比，三联式 DMEK 是一种快速恢复视力的有效策略，具有 1 期手术的优势，降低了风险和成本。
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