Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands.
Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands.
Ophthalmology. 2015 Mar;122(3):464-70. doi: 10.1016/j.ophtha.2014.09.004. Epub 2014 Oct 22.
To evaluate the clinical outcome of 500 consecutive cases after Descemet's membrane endothelial keratoplasty (DMEK) and the effect of technique standardization.
Prospective, interventional case series at a tertiary referral center.
A total of 500 eyes of 393 patients who underwent DMEK for Fuchs' endothelial corneal dystrophy, bullous keratopathy, or previous corneal transplant failure.
Best-corrected visual acuity (BCVA), endothelial cell density (ECD), pachymetry, and intraoperative and postoperative complications were evaluated before and 1, 3, and 6 months after DMEK.
Comparison between 2 groups (group I: cases 1-250, outcome of "early surgeries" during transition to technique standardization; group II: cases 251-500, outcome of "late surgeries" after technique standardization).
At 6 months, 75% of eyes reached a BCVA of ≥20/25 (≥0.8), 41% of eyes achieved ≥20/20 (≥1.0), and 13% of eyes achieved ≥20/18 (≥1.2) (n=418) when excluding eyes with ocular comorbidities (n=57). When including all available eyes at 6 months (n=475), 66% of eyes reached a BCVA of ≥20/25 (≥0.8), and 36% of eyes achieved ≥20/20 (≥1.0). Mean ECD decreased by 37% (±18%) to 1600 (±490) cells/mm2 (n=447) at 6 months (P<0.001). Postoperative pachymetry averaged 525 (±46) μm compared with 667 (±92) μm preoperatively (P<0.001). None of these parameters differed among the 2 groups (P>0.05). (Partial) graft detachment presented in 79 eyes (15.8%), and 26 eyes (5.2%) required a secondary surgery within the first 6 months (re-bubbling in 15, secondary keratoplasty in 11). With technique standardization, the postoperative complication rate decreased from 23.2% to 10% (P<0.001) and the rate of secondary surgeries decreased from 6.8% to 3.6% (P=0.10).
In comparison with earlier endothelial keratoplasty techniques, DMEK may consistently give higher visual outcomes and faster visual rehabilitation. When used for the extended spectrum of endothelial pathologies, DMEK proved feasible with a relatively low risk of complications. Technique standardization may have contributed to a lower graft detachment rate and a relatively low secondary intervention rate. As such, DMEK may become the first choice of treatment in corneal endothelial disease.
评估 500 例连续接受 Descemet 膜内皮角膜移植术（DMEK）的临床结果，并评估技术标准化的效果。
在一家三级转诊中心进行的前瞻性、干预性病例系列研究。
共有 393 例患者的 500 只眼接受了 DMEK 治疗，这些患者患有 Fuchs 内皮角膜营养不良、大泡性角膜病变或先前的角膜移植失败。
在 DMEK 术前、术后 1、3 和 6 个月，评估最佳矫正视力（BCVA）、内皮细胞密度（ECD）、角膜厚度和术中及术后并发症。
比较两组（第 I 组：病例 1-250，为过渡到技术标准化的“早期手术”；第 II 组：病例 251-500，为技术标准化后的“晚期手术”）的结果。
6 个月时，当排除患有眼部合并症的患者（n=57）时，75%的眼达到了≥20/25（≥0.8）的 BCVA，41%的眼达到了≥20/20（≥1.0），13%的眼达到了≥20/18（≥1.2）（n=418）。当包括 6 个月时所有可获得的眼（n=475）时，66%的眼达到了≥20/25（≥0.8），36%的眼达到了≥20/20（≥1.0）。术后 6 个月时，ECD 平均下降 37%（±18%）至 1600（±490）个细胞/mm2（n=447）（P<0.001）。术后角膜厚度平均为 525（±46）μm，术前为 667（±92）μm（P<0.001）。两组之间这些参数没有差异（P>0.05）。（部分）移植物脱离发生在 79 只眼中（15.8%），26 只眼（5.2%）在最初的 6 个月内需要进行二次手术（15 只眼再气泡，11 只眼再次角膜移植）。通过技术标准化，术后并发症发生率从 23.2%下降至 10%（P<0.001），二次手术率从 6.8%下降至 3.6%（P=0.10）。
与早期的角膜内皮手术技术相比，DMEK 可能始终提供更高的视力结果和更快的视力恢复。当用于扩展的内皮病变谱时，DMEK 具有相对较低的并发症风险。技术标准化可能有助于降低移植物脱离率和相对较低的二次干预率。因此，DMEK 可能成为角膜内皮疾病的首选治疗方法。
