Schaub Friederike, Pohl Layla, Enders Philip, Adler Werner, Bachmann Björn O, Cursiefen Claus, Heindl Ludwig M
Department of Ophthalmology, University of Cologne, Kerpener Strasse 62 -, 50924, Cologne, Germany.
Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander, University Erlangen-Nürnberg, Erlangen, Germany.
Graefes Arch Clin Exp Ophthalmol. 2017 Dec;255(12):2407-2414. doi: 10.1007/s00417-017-3827-2. Epub 2017 Oct 15.
Our purpose was to investigate the impact of lens status of corneal donors on the two-year course and clinical outcome of Descemet membrane endothelial keratoplasty (DMEK).
In 181 DMEK surgeries, 136 phakic and 45 pseudophakic donor corneas were grafted. In this retrospective audit we compared the lens status of corneal donors regarding the outcome measures best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), and endothelial cell density (ECD) at 1, 3, 6, 12, and 24 months, as well as intra- and postoperative complication rates and graft detachment rates requiring re-bubbling.
Comparing the use of phakic and pseudophakic donor tissue in DMEK surgery, BSCVA results revealed no significant differences during the two-year course (p ≥ 0.087). CCT showed significantly lower values at 1 month (553.8 ± 56 vs. 625.2 ± 119 μm; p < 0.001) and 6 months follow-up (530.6 ± 49.9 vs. 557.3 ± 47 μm; p = 0.026) for phakic donor tissue recipients, but were comparable later (p ≥ 0.173). ECD values were statistically higher 6 (1915 ± 390 vs. 1565 ± 420 cells/mm; p < 0.001) and 24 months postoperatively (1772 ± 384 vs. 1375 ± 377 cells/mm; p = 0.030) in phakic donor tissue recipients. Mixed regression analyses demonstrated a significant association between ECD results and donor lens status (p = 0.029) and donor ECD (p = 0.028), but donor age did not show significant influence (p = 0.241).
ECD is higher in phakic corneal donors and appears to remain at a higher level during the course resulting in initially faster reduction of corneal edema compared to pseudophakic DMEK grafts. Nevertheless, pseudophakic transplants with high ECD seem to produce comparable functional results in recipients after a two year course.
我们的目的是研究角膜供体的晶状体状态对Descemet膜内皮角膜移植术（DMEK）两年病程及临床结果的影响。
在181例DMEK手术中，移植了136枚有晶状体和45枚无晶状体供体角膜。在这项回顾性审计中，我们比较了角膜供体的晶状体状态在1、3、6、12和24个月时的最佳矫正视力（BSCVA）、中央角膜厚度（CCT）和内皮细胞密度（ECD）等结果指标，以及术中和术后的并发症发生率和需要再次注入空气的移植片脱离率。
比较DMEK手术中有晶状体和无晶状体供体组织的使用情况，BSCVA结果显示在两年病程中无显著差异（p≥0.087）。有晶状体供体组织受者在1个月（553.8±56 vs. 625.2±119μm；p<0.001）和6个月随访时（530.6±49.9 vs. 557.3±47μm；p=0.026）的CCT值显著较低，但后期相当（p≥0.173）。有晶状体供体组织受者术后6个月（1915±390 vs. 1565±420个细胞/mm²；p<0.001）和24个月（1772±384 vs. 1375±377个细胞/mm²；p=0.030）的ECD值在统计学上较高。混合回归分析表明ECD结果与供体晶状体状态（p=0.029）和供体ECD（p=0.028）之间存在显著关联，但供体年龄未显示出显著影响（p=0.241）。
有晶状体角膜供体的ECD较高，并且在病程中似乎保持在较高水平，与无晶状体DMEK移植片相比，最初角膜水肿的减轻更快。然而，两年病程后，ECD高的无晶状体移植片在受者中似乎能产生相当的功能结果。
