Einan-Lifshitz Adi, Sorkin Nir, Boutin Tanguy, Showail Mahmood, Borovik Armand, Alobthani Murad, Chan Clara C, Rootman David S
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
Cornea. 2017 Jul;36(7):767-770. doi: 10.1097/ICO.0000000000001217.
To introduce a novel method to perform descemetorhexis in Descemet membrane endothelial keratoplasty (DMEK) using the femtosecond laser and to compare it with Descemet membrane endothelial keratoplasty performed with manual descemetorhexis (M-DMEK).
A retrospective medical chart review of 2 groups of patients who underwent DMEK surgery combined with cataract surgery secondary to Fuchs corneal endothelial dystrophy and cataract: 17 patients underwent femtosecond laser-enabled descemetorhexis Descemet membrane endothelial keratoplasty (FE-DMEK) and 89 patients underwent DMEK surgery with M-DMEK. Best spectacle-corrected visual acuity, endothelial cell density (ECD), graft detachment rate, and complications were compared.
Average age of the 106 patients (64 women and 42 men) was 68 ± 11 years. Postoperative best spectacle-corrected visual acuity was 0.19 ± 0.13 logarithm of the minimum angle of resolution in the FE-DMEK group and 0.35 ± 0.48 logarithm of the minimum angle of resolution in the M-DMEK group (P = 0.218). One day after surgery, there were no significant graft detachments in the FE-DMEK group, compared with 20% graft detachment rate in the M-DMEK group (P = 0.041). Rebubbling was performed in 17% of eyes in the M-DMEK group compared with none in the FE-DMEK group (P = 0.066). The mean endothelial cell count in the FE-DMEK and M-DMEK groups at 6 months after surgery were 2105 ± 285 cells per square millimeter (24% cells loss) and 1990 ± 600 cells per square millimeter (29% cells loss), respectively (P = 0.579).
FE-DMEK shows efficacy similar to that of M-DMEK with apparently less graft detachment and reduced need for rebubbling.
介绍一种在Descemet膜内皮角膜移植术（DMEK）中使用飞秒激光进行后弹力层撕除的新方法，并将其与采用手动后弹力层撕除术（M-DMEK）进行的Descemet膜内皮角膜移植术相比较。
对两组因Fuchs角膜内皮营养不良合并白内障而接受DMEK手术联合白内障手术的患者进行回顾性病历分析：17例患者接受了飞秒激光辅助后弹力层撕除的Descemet膜内皮角膜移植术（FE-DMEK），89例患者接受了M-DMEK的DMEK手术。比较最佳矫正视力、内皮细胞密度（ECD）、植片脱离率及并发症。
106例患者（64例女性和42例男性）的平均年龄为68±11岁。术后最佳矫正视力在FE-DMEK组为最小分辨角对数视力0.19±0.13，在M-DMEK组为最小分辨角对数视力0.35±0.48（P = 0.218）。术后1天，FE-DMEK组无明显植片脱离，而M-DMEK组的植片脱离率为20%（P = 0.041）。M-DMEK组17%的患眼进行了再次注气，而FE-DMEK组无一例（P = 0.066）。术后6个月，FE-DMEK组和M-DMEK组的平均内皮细胞计数分别为每平方毫米2105±285个细胞（细胞损失24%）和每平方毫米1990±600个细胞（细胞损失29%）（P = 0.579）。
FE-DMEK显示出与M-DMEK相似的疗效，且植片脱离明显减少，再次注气的需求降低。
