Iovieno Alfonso, Neri Alberto, Soldani Anna Maria, Adani Chantal, Fontana Luigi
Department of Ophthalmology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
Cornea. 2017 Jun;36(6):637-641. doi: 10.1097/ICO.0000000000001202.
To report our preliminary experience with a central descemetorhexis without graft placement in Fuchs endothelial corneal dystrophy (FECD) and to review the existing literature on the topic.
A 4-mm central descemetorhexis was performed in 5 patients (4 women, 1 man; mean age: 69.8 ± 8.6 yrs; range: 57-78 yrs) with FECD. All patients had central confluent guttae, undetectable central endothelial cell count, healthy peripheral corneal endothelium, no clinically evident bullous keratopathy, and no ocular comorbidities. In 3 patients, the procedure was combined with phacoemulsification and intraocular lens implantation.
All patients completed at least 6 months of postoperative follow-up (mean follow-up 9 ± 2.5 mo; 7-13 mo). Endothelial repopulation of the central stroma was completed in all patients by the third month. Corneal clarity was achieved in 4 of 5 patients. The patient with persistent edema and haze had the highest preoperative central pachymetry. A final improvement in corrected visual acuity was achieved in 4/5 patients. A reduction in preoperative central pachymetry was observed in all cases. All patients developed deep stromal opacities around the margin of the descemetorhexis, which did not resolve over the follow-up time. Abnormal corneal topography and irregular astigmatism developed in 3 of 5 patients; these patients achieved 20/20 corrected distance visual acuity with rigid gas-permeable contact lens fitting.
In partial concordance with previous studies, preliminary outcomes of a central descemetorhexis in FECD performed without endothelial graft placement seemed rather unpredictable. Baring of central stroma may trigger a variable wound-healing response with subsequent posterior stromal scarring and topographical irregularity.
报告我们在富克斯内皮性角膜营养不良（FECD）患者中进行无移植片植入的中央后弹力层撕除术的初步经验，并回顾该主题的现有文献。
对5例FECD患者（4例女性，1例男性；平均年龄：69.8±8.6岁；范围：57 - 78岁）进行了4毫米的中央后弹力层撕除术。所有患者均有中央融合性角膜小滴，中央内皮细胞计数无法检测，周边角膜内皮健康，无临床明显的大疱性角膜病变，且无眼部合并症。3例患者该手术与白内障超声乳化吸除及人工晶状体植入术联合进行。
所有患者术后至少随访6个月（平均随访9±2.5个月；7 - 13个月）。所有患者在第三个月时中央基质的内皮细胞重新生长完成。5例患者中有4例角膜恢复透明。持续水肿和混浊的患者术前中央角膜厚度最高。5例患者中有4例最终矫正视力得到改善。所有病例均观察到术前中央角膜厚度降低。所有患者在撕除后弹力层边缘周围均出现深层基质混浊，在随访期间未消退。5例患者中有3例出现异常角膜地形图和不规则散光；这些患者通过佩戴硬性透气性角膜接触镜矫正后达到了20/20的远视力。
与先前的研究部分一致，在FECD患者中进行无内皮移植片植入的中央后弹力层撕除术的初步结果似乎相当不可预测。中央基质的裸露可能引发可变的伤口愈合反应，随后出现后基质瘢痕形成和地形不规则。
