Hayashi Takahiko, Yamaguchi Takefumi, Yuda Kentaro, Kato Naoko, Satake Yoshiyuki, Shimazaki Jun
Department of Ophthalmology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan.
Department of Ophthalmology, Yokohama City University School of Medicine, Kanagawa, Japan.
PLoS One. 2017 Nov 30;12(11):e0188832. doi: 10.1371/journal.pone.0188832. eCollection 2017.
To investigate the topographic characteristics of the posterior corneal surface after Descemet's endothelial membrane keratoplasty (DMEK) and Descemet's stripping automated endothelial keratoplasty (DSAEK) and their effects on postoperative visual acuity.
Nineteen eyes of 19 patients after DMEK, 23 eyes of 23 patients after DSAEK, and 18 eyes of 18 control subjects were retrospectively analyzed. Best spectacle-corrected visual acuity (BSCVA), aberration factors (higher-order aberrations [HOAs], spherical aberrations [SAs], and coma aberrations [Comas] at 6.0 mm) were evaluated preoperatively and at 1, 3, and 6 months postoperatively. The posterior refractive pattern of the topography map was classified into 5 grades (0-5) (posterior color grade) using anterior segment optical coherence tomography. Correlations between BSCVA and some factors (abbreviation factors, posterior color grade) were analyzed.
BSCVA was significantly better after DMEK than after DSAEK (P < 0.001). Posterior HOAs, SAs, and Comas after each type of endothelial keratoplasty were significantly greater compared to control (P < 0.01). Posterior HOAs, total/anterior/posterior SAs, and posterior color grade were significantly lower in the DMEK group than in the DSAEK group at 3 months (P < 0.024 [posterior HOAs], P = 0.047 [total SA], P < 0.001 [anterior SAs], P = 0.021 [posterior SAs], and P < 0.001 [posterior color grade]) and 6 months postoperatively (P = 0.034 [posterior HOAs], P < 0.001 [total SAs], P < 0.001 [anterior SAs], P = 0.013 [posterior SAs], and P = 0.004 [posterior color grade]). BSCVA was significantly correlated with HOAs, SAs, and posterior color grade (P < 0.001 for all except anterior HOAs [P = 0.004]).
High posterior color grades were associated with larger aberration factors and had a negative effect on visual function after endothelial keratoplasty. Rapid improvement of visual function after DMEK may be attributed to less change at the posterior surface.
研究Descemet膜内皮角膜移植术（DMEK）和Descemet膜剥除自动内皮角膜移植术（DSAEK）后角膜后表面的地形特征及其对术后视力的影响。
回顾性分析19例DMEK术后患者的19只眼、23例DSAEK术后患者的23只眼以及18例对照者的18只眼。术前及术后1、3和6个月评估最佳矫正视力（BSCVA）、像差因子（6.0mm处的高阶像差[HOAs]、球差[SAs]和彗差[Comas]）。使用眼前节光学相干断层扫描将地形图的后屈光模式分为5个等级（0-5）（后颜色等级）。分析BSCVA与一些因素（缩写因子、后颜色等级）之间的相关性。
DMEK术后的BSCVA显著优于DSAEK术后（P<0.001）。与对照组相比，每种内皮角膜移植术后的后HOAs、SAs和Comas均显著更大（P<0.01）。DMEK组术后3个月（P<0.024[后HOAs]，P=0.047[总SA]，P<0.001[前SA]，P=0.021[后SA]，P<0.001[后颜色等级]）和6个月时（P=0.034[后HOAs]，P<0.001[总SAs]，P<0.001[前SAs]，P=0.013[后SAs]，P= 0.004[后颜色等级]），后HOAs、总/前/后SAs和后颜色等级均显著低于DSAEK组。BSCVA与HOAs、SAs和后颜色等级显著相关（除前HOAs外均P<0.001[P=0.004]）。
高后颜色等级与更大的像差因子相关，并且对内皮角膜移植术后的视觉功能有负面影响。DMEK术后视觉功能的快速改善可能归因于后表面变化较小。
