Weller Julia M, Tourtas Theofilos, Kruse Friedrich E, Schlötzer-Schrehardt Ursula, Fuchsluger Thomas, Bachmann Björn O
Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
Am J Ophthalmol. 2015 Jun;159(6):1050-1057.e2. doi: 10.1016/j.ajo.2015.03.010. Epub 2015 Mar 16.
To investigate the outcome of Descemet membrane endothelial keratoplasty (DMEK) in patients with graft failure after Descemet stripping automated endothelial keratoplasty (DSAEK).
Retrospective cohort study.
setting: Institutional.
Fifteen eyes of 15 patients that underwent DMEK for graft failure with corneal decompensation following DSAEK were analyzed; 15 eyes with primary DMEK for Fuchs corneal dystrophy were included as control group.
Best-corrected visual acuity (BCVA), endothelial cell density (ECD), central corneal thickness (CCT), and rebubbling rate.
DMEK surgery was successful in all cases of both groups. Mean BCVA (logMAR) before DMEK was 1.27 ± 0.34 in the DMEK after DSAEK group and 1.0 ± 0.40 in the Primary DMEK group. After DMEK, mean BCVA increased significantly to 0.23 ± 0.21 (P = .012, DMEK after DSAEK group) and 0.29 ± 0.23 (P = .042, Primary DMEK group) after 3 months. There were no significant differences in mean BCVA between both groups at each visit. The rebubbling rate was 13% in the DMEK after DSAEK group and 40% in the Primary DMEK group (P = .1). Mean CCT decreased significantly in both groups 1 month after DMEK (P < .05). Mean ECD and change of ECD did not differ significantly between both groups at each visit (P > .05).
The results after DMEK as a procedure to treat graft failure after DSAEK were as good as in patients that underwent DMEK as primary intervention to treat advanced Fuchs dystrophy. This indicates that the optical quality can be reestablished by DMEK in patients with failed DSAEK.
探讨在角膜后弹力层剥除自动内皮角膜移植术（DSAEK）后发生植片失败的患者中，后弹力层内皮角膜移植术（DMEK）的治疗效果。
回顾性队列研究。
研究机构。
分析15例患者的15只眼，这些患者在DSAEK后因角膜失代偿植片失败而接受了DMEK治疗；纳入15只因Fuchs角膜营养不良首次接受DMEK治疗的眼作为对照组。
最佳矫正视力（BCVA）、内皮细胞密度（ECD）、中央角膜厚度（CCT）和再气泡形成率。
两组所有病例的DMEK手术均成功。DSAEK术后行DMEK组术前平均BCVA（logMAR）为1.27±0.34，首次行DMEK组为1.0±0.40。DMEK术后3个月，DSAEK术后行DMEK组平均BCVA显著提高至0.23±0.21（P = 0.012），首次行DMEK组为0.29±0.23（P = 0.042）。每次随访时两组间平均BCVA均无显著差异。DSAEK术后行DMEK组的再气泡形成率为13%，首次行DMEK组为40%（P = 0.1）。DMEK术后1个月两组平均CCT均显著降低（P < 0.05）。每次随访时两组间平均ECD及ECD变化均无显著差异（P > 0.05）。
作为治疗DSAEK后植片失败的一种手术，DMEK的治疗效果与作为治疗晚期Fuchs角膜营养不良的初次干预措施的DMEK患者的效果一样好。这表明DMEK可在DSAEK失败的患者中重建光学质量。
