Tourtas Theofilos, Weller Julia M, Bachmann Bjoern O, Kruse Friedrich E
Department of Ophthalmology, University of Erlangen-Nuremberg, Erlangen, Germany.
Eye Contact Lens. 2015 Nov;41(6):344-8. doi: 10.1097/ICL.0000000000000125.
To evaluate the incidence of peripheral corneal edema after Descemet membrane endothelial keratoplasty (DMEK) with respect to the size of the descemetorhexis.
A single-center retrospective review of data of 200 consecutive DMEK surgeries for Fuchs endothelial dystrophy was performed. Forty-eight eyes of 47 patients were enrolled in this study based on the presence of a peripheral zone of free denuded stroma between the margin of the graft and the host's Descemet membrane (DM) (group A) or a peripheral overlap between the graft and the host's DM (group B). In group A (n=26 eyes), the diameter of the descemetorhexis was approximately 10 mm, whereas in group B (n=22 eyes), the diameter was approximately 6 mm. Both groups received an 8-mm graft. Main outcome measures included peripheral corneal thickness (PCT) at 4 mm from the center, central corneal thickness (CCT), central-to-peripheral thickness ratio (CPTR), and endothelial cell density (ECD).
Mean preoperative PCT±SD in group A was 728±52 μm and in group B was 708±49 μm (P=0.192). Four weeks after DMEK, mean PCT±SD was 703±43 μm in group A and 691±59 μm in group B (P=0.368). Mean preoperative CCT±SD was 642±53 μm and 627±58 μm in groups A and B, respectively (P=0.306). There was no significant difference in CCT between groups A and B 4 weeks after surgery (P=0.268). Mean preoperative CPTR±SD in group A was 0.88±0.05 and in group B was 0.89±0.05 (P=0.934). Four weeks after DMEK, CPTR was not significantly different between groups A and B (P=0.893). There was no significant difference in ECD between groups A and B, before and at 4 weeks after DMEK (P=0.093 and P=0.831, respectively).
A larger descemetorhexis in DMEK resulting in a peripheral small zone of denuded stroma does not increase the incidence of peripheral corneal edema as compared with a small descemetorhexis with overlapping DMs.
评估在Descemet膜内皮角膜移植术（DMEK）后，周边角膜水肿的发生率与后弹力层撕除大小的关系。
对200例连续进行的针对Fuchs内皮营养不良的DMEK手术数据进行单中心回顾性分析。基于移植片边缘与宿主后弹力层（DM）之间存在游离裸露基质的周边区域（A组）或移植片与宿主DM之间存在周边重叠（B组），47例患者的48只眼被纳入本研究。在A组（n = 26只眼）中，后弹力层撕除的直径约为10 mm，而在B组（n = 22只眼）中，直径约为6 mm。两组均接受8 mm的移植片。主要观察指标包括距中心4 mm处的周边角膜厚度（PCT）、中央角膜厚度（CCT）、中央与周边厚度比（CPTR）以及内皮细胞密度（ECD）。
A组术前平均PCT±标准差为728±52 μm，B组为708±49 μm（P = 0.192）。DMEK术后4周，A组平均PCT±标准差为703±43 μm，B组为691±59 μm（P = 0.368）。A组和B组术前平均CCT±标准差分别为642±53 μm和627±58 μm（P = 0.306）。术后4周A组和B组的CCT无显著差异（P = 0.268）。A组术前平均CPTR±标准差为0.88±0.05，B组为0.89±0.05（P = 0.934）。DMEK术后4周，A组和B组的CPTR无显著差异（P = 0.893）。在DMEK术前及术后4周，A组和B组的ECD无显著差异（分别为P = 0.093和P = 0.831）。
与后弹力层撕除较小且DM重叠的情况相比，DMEK中较大的后弹力层撕除导致周边小区域的裸露基质不会增加周边角膜水肿的发生率。
