Reid Robert A, Craig Ewan A, Suleman Hanif
Department of Ophthalmology, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, UK.
Br J Ophthalmol. 2015 Feb;99(2):166-9. doi: 10.1136/bjophthalmol-2014-305956. Epub 2014 Oct 21.
To evaluate the clinical outcomes of Descemet's membrane endothelial keratoplasty (DMEK) in the treatment of patients with Fuchs' endothelial dystrophy.
This prospective study involved 16 consecutive patients who had DMEK done and who were evaluated over a year. Measurements included best corrected visual acuity (BCVA), endothelial cell count, and central corneal thickness.
Two patients had failed grafts. Of the remaining 14 patients with successful grafts, after 12 months, 79% had BCVA of 6/6 or better, and all patients had a BCVA of 6/9 or better. Median endothelial cell count was 1567 cells per mm(2) (range=900-2359) representing a 40% reduction compared with preoperative counts. Median central corneal thickness was 498 µm (range 445-567 µm) compared with a median of 649 µm (range 548-740 µm) preoperatively. All patients attained total visual rehabilitation without further surgical intervention.
In our experience, DMEK has the potential to become the primary procedure for treating Fuchs' endothelial dystrophy and endothelial disease as it produces rapid total visual rehabilitation with few complications, and an easy follow-up and management regimen. Donor preparation and graft insertion, however, remain important challenges.
评估Descemet膜内皮角膜移植术（DMEK）治疗Fuchs内皮营养不良患者的临床疗效。
这项前瞻性研究纳入了连续16例行DMEK手术并接受了一年评估的患者。测量指标包括最佳矫正视力（BCVA）、内皮细胞计数和中央角膜厚度。
2例患者移植失败。其余14例移植成功的患者在12个月后，79%的患者BCVA达到6/6或更好，所有患者的BCVA均达到6/9或更好。内皮细胞计数中位数为每平方毫米1567个细胞（范围为900 - 2359），与术前计数相比减少了40%。中央角膜厚度中位数为498 µm（范围为445 - 567 µm），而术前中位数为649 µm（范围为548 - 740 µm）。所有患者均实现了完全视觉康复，无需进一步手术干预。
根据我们的经验，DMEK有可能成为治疗Fuchs内皮营养不良和内皮疾病的主要手术方法，因为它能快速实现完全视觉康复，并发症少，且随访和管理方案简便。然而，供体准备和植片植入仍然是重要挑战。
