Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands2Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands.
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands2Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands3Allgemeines Krankenhaus Linz, Linz, Austria.
JAMA Ophthalmol. 2014 Dec;132(12):1469-73. doi: 10.1001/jamaophthalmol.2014.3328.
This study evaluates the technical feasibility and clinical outcomes of a Descemet membrane endothelial keratoplasty (DMEK) technique that could increase the availability of donor tissue for DMEK.
To evaluate the clinical outcome of using a semicircular, large-diameter Descemet membrane graft in DMEK (hemi-DMEK), potentially allowing the use of a single donor cornea for 2 DMEK procedures.
DESIGN, SETTING, AND PARTICIPANTS: A prospective, interventional case series was conducted at a tertiary referral center. Three eyes of 3 patients with Fuchs endothelial dystrophy received a hemi-DMEK.
Transplantation of a semicircular, large-diameter hemi-DMEK graft.
Best-corrected visual acuity, endothelial cell density, pachymetry, and intraoperative and postoperative complications.
The patients' best-corrected visual acuity at 6 months was 0.70 (Snellen equivalent, 20/29), 0.50 (20/40 [amblyopic eye]), and 1.20 (20/17). At 1 month, endothelial cell density decreased by 49%, 31%, and 39%, respectively, and endothelial cell migration appeared to continue for up to 6 months. Central corneal thicknesses decreased from 682, 707, and 681 μm before surgery to 523, 534, and 489 μm, respectively, at 6 months. No intraoperative or postoperative complications were seen.
Hemi-DMEK (using half-moon-shaped grafts) is technically feasible and may provide visual outcomes similar to those obtained with routine DMEK (full-moon-shaped graft). If so, this technique may have the potential to double the availability of donor endothelial tissue for DMEK surgery.
本研究评估了一种可能增加供体组织用于 DMEK 的半环型、大直径 Descemet 膜内皮角膜移植术（DMEK）技术的技术可行性和临床结果。
评估在 DMEK 中使用半环型、大直径 Descemet 膜移植物（半 DMEK）的临床结果，这可能使单个供体角膜可用于 2 次 DMEK 手术。
设计、地点和参与者：在一个三级转诊中心进行了一项前瞻性、干预性病例系列研究。3 名 Fuchs 内皮营养不良患者的 3 只眼接受了半 DMEK。
移植半环型、大直径半 DMEK 移植物。
最佳矫正视力、内皮细胞密度、角膜厚度和术中及术后并发症。
患者术后 6 个月的最佳矫正视力分别为 0.70（Snellen 等价物，20/29）、0.50（弱视眼，20/40）和 1.20（20/17）。术后 1 个月，内皮细胞密度分别下降 49%、31%和 39%，内皮细胞迁移似乎持续至 6 个月。中央角膜厚度分别从术前的 682、707 和 681μm 下降至术后 6 个月的 523、534 和 489μm。未观察到术中或术后并发症。
半 DMEK（使用半月形移植物）在技术上是可行的，并且可能提供与常规 DMEK（全月形移植物）相似的视力结果。如果是这样，这种技术可能有潜力使 DMEK 手术的供体内皮组织可用性增加一倍。
