Department of Ophthalmology, University of Cologne, Cologne, Germany.
Cornea. 2014 Nov;33(11):1134-9. doi: 10.1097/ICO.0000000000000250.
Recent studies have identified diminishment of corneal nerves as another hallmark of Fuchs endothelial corneal dystrophy. This study aimed to analyze changes in corneal nerves after Descemet membrane endothelial keratoplasty (DMEK).
Twenty-five patients were assessed for nerve alterations preoperatively and 1 week, 4 months, and 20 months after DMEK surgery. Morphology of the central subbasal nerve plexus was quantified by in vivo confocal microscopy.
The total nerve length (481.2 ± 81.9 vs. 1536.0 ± 123.8 μm per frame, P < 0.0001), total nerve number (2.2 ± 0.3 vs. 7.2 ± 0.5 per frame, P < 0.0001), number of main nerve trunks (1.8 ± 0.2 vs. 3.5 ± 0.3 per frame, P < 0.0001), and number of nerve branches (0.5 ± 0.2 vs. 3.7 ± 0.4 per frame, P < 0.0001) were significantly decreased 1 week after DMEK compared with preoperative measurements. Ten months postoperatively, corneal nerves recovered to preoperative values. Central corneal sensation significantly reduced postoperatively (5.1 ± 1.0 vs. 6.0 ± 0.0, P = 0.001), but recovered during follow-up (10 months: 6.0 ± 0.0).
DMEK diminishes the density and the function of subbasal corneal nerves early after transplantation. However, a complete recovery of corneal nerve density and function up to preoperative values occurs within 4 to 10 months.
最近的研究表明，角膜神经减少是 Fuchs 内皮角膜营养不良的另一个标志。本研究旨在分析 Descemet 膜内皮角膜移植术（DMEK）后角膜神经的变化。
对 25 例患者进行术前、术后 1 周、4 个月和 20 个月的神经改变评估。通过活体共聚焦显微镜定量分析中央基底神经丛的形态。
术后 1 周，总神经长度（481.2±81.9 比 1536.0±123.8μm/帧，P<0.0001）、总神经数量（2.2±0.3 比 7.2±0.5/帧，P<0.0001）、主神经干数量（1.8±0.2 比 3.5±0.3/帧，P<0.0001）和神经分支数量（0.5±0.2 比 3.7±0.4/帧，P<0.0001）均显著减少。术后 10 个月，角膜神经恢复至术前水平。术后中央角膜感觉明显降低（5.1±1.0 比 6.0±0.0，P=0.001），但在随访期间恢复（10 个月：6.0±0.0）。
DMEK 可在移植后早期降低基底角膜神经的密度和功能。然而，角膜神经密度和功能可在 4 至 10 个月内完全恢复至术前水平。
