Department of Ophthalmology, University of Erlangen-Nuremberg, Erlangen, Germany.
JAMA Ophthalmol. 2014 Feb;132(2):155-61. doi: 10.1001/jamaophthalmol.2013.6222.
It is essential to devise strategies that improve graft adhesion after Descemet membrane endothelial keratoplasty (DMEK) to reduce the rebubbling rate.
To evaluate the influence of the extent of descemetorhexis on graft adhesion properties after DMEK.
DESIGN, SETTING, AND PARTICIPANTS: Single-surgeon, retrospective, observational case series conducted in the Department of Ophthalmology, University of Erlangen-Nuremberg, Germany, that reviewed the medical records of 200 consecutive patients undergoing DMEK. Fifty-three eyes of 51 patients undergoing DMEK for Fuchs endothelial dystrophy fulfilling the inclusion criteria were enrolled in this study. Based on intraoperative drawings, postoperative slitlamp examination, and photographs, eyes were divided into 2 groups. The diameter of the descemetorhexis was approximately 10 mm in group A (30 eyes), resulting in a peripheral 1-mm zone of denuded stroma between the graft and the host's Descemet membrane, and approximately 6 mm in group B (23 eyes), resulting in a peripheral 1-mm zone of overlapping between the graft and the host's Descemet membrane.
Graft detachment rate, extent of graft detachment (in clock hours of graft's circumference), and rebubbling rate.
Four days after DMEK, the graft detachment rate was 33.3% (10 of 30) in group A and 78.3% (18 of 23) in group B (P = .002). The mean (SD) extent of graft detachment was 0.6 (0.9) and 2.8 (2.5) clock hours in groups A and B, respectively (P < .001), 4 days after surgery. The rebubbling rate was 6.7% (2 of 30) and 30.4% (7 of 23) for groups A and B, respectively (P = .03).
A larger descemetorhexis in DMEK is correlated with better graft adhesion and lower rebubbling rates. Therefore, patients with a larger descemetorhexis require less intensive follow-up.
制定策略以改善去表皮后基质角膜内皮移植术（DMEK）后的移植物附着，以降低再灌流率是至关重要的。
评估撕囊的范围对 DMEK 后移植物附着特性的影响。
设计、地点和参与者：这项在德国纽伦堡大学眼科进行的、由一位外科医生开展的回顾性、观察性的单病例系列研究，回顾了 200 例连续接受 DMEK 的患者的病历。本研究纳入了符合纳入标准的因 Fuchs 内皮营养不良而接受 DMEK 的 51 例 53 只眼。根据术中绘图、术后裂隙灯检查和照片，将眼分为 2 组。组 A（30 只眼）的撕囊直径约为 10mm，导致移植物和供体的角膜内皮之间存在 1mm 的周边无基质区，组 B（23 只眼）的撕囊直径约为 6mm，导致移植物和供体的角膜内皮之间存在 1mm 的周边重叠区。
移植物脱离率、移植物脱离的程度（以移植物周长的时钟小时数表示）和再灌流率。
DMEK 后 4 天，组 A 的移植物脱离率为 33.3%（10/30），组 B 为 78.3%（18/23）（P= .002）。术后 4 天，组 A 和组 B 的移植物脱离程度的平均值（标准差）分别为 0.6（0.9）和 2.8（2.5）时钟小时（P< .001）。组 A 和组 B 的再灌流率分别为 6.7%（2/30）和 30.4%（7/23）（P= .03）。
DMEK 中的较大撕囊与更好的移植物附着和更低的再灌流率相关。因此，撕囊较大的患者需要较少的密集随访。
