Droutsas Konstantinos, Lazaridis Apostolos, Giallouros Eleftherios, Kymionis Georgios, Chatzistefanou Klio, Sekundo Walter
Ophthalmology Department, the Philipps University Marburg, Marburg, Germany.
First Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece.
Cornea. 2018 Apr;37(4):455-461. doi: 10.1097/ICO.0000000000001483.
To compare the course of Scheimpflug corneal densitometry (CD) after Descemet membrane endothelial keratoplasty (DMEK) versus Descemet stripping automated endothelial keratoplasty (DSAEK).
Fifty-four DMEK and 25 DSAEK cases without previous corneal surgery, complicated intraoperative or postoperative course, or vision-limiting ocular comorbidities were included. Pseudophakic eyes of age-matched subjects were recruited as controls (n = 20). Scheimpflug CD of the optically relevant zones (0-2 and 2-6 mm), best-corrected visual acuity (BCVA), endothelial cell density, and central corneal thickness were evaluated preoperatively and at 3, 6, 12, and 24 months postoperatively.
CD of the optical zone decreased from 34.4 ± 9.4 grayscale units (GSU) before to 19.2 ± 2.7 GSU at 24 months after DMEK. Respectively, CD decreased from 34.0 ± 13.4 GSU before to 21.2 ± 2.5 GSU at 24 months after DSAEK. Mean central CD in group 3 was 18.1 ± 1.3 GSU. Compared with DSAEK, DMEK cases showed lower central CD at 3 and 6 months (P ≤ 0.012) but not at 12 and 24 months postoperatively. DSAEK showed higher CD values throughout the postoperative period compared with healthy controls (P < 0.001). DMEK showed higher CD compared with controls at 3, 6, and 12 but not at 24 months after surgery (P = 0.152). Postoperative BCVA was significantly better after DMEK for every examination time point. No difference in endothelial cell density was found between DMEK and DSAEK at any time point.
DMEK showed lower CD and better BCVA compared with DSAEK in the first 6 postoperative months. Notably, although CD reached similar levels in the midterm after both DMEK and DSAEK, BCVA remained significantly better after DMEK.
比较Descemet膜内皮角膜移植术（DMEK）与Descemet膜剥除自动内皮角膜移植术（DSAEK）后Scheimpflug角膜密度测量（CD）的变化过程。
纳入54例DMEK病例和25例DSAEK病例，这些病例既往无角膜手术史、术中或术后无复杂病程或无影响视力的眼部合并症。招募年龄匹配的假晶状体眼受试者作为对照（n = 20）。术前及术后3、6、12和24个月评估光学相关区域（0 - 2和2 - 6 mm）的Scheimpflug CD、最佳矫正视力（BCVA）、内皮细胞密度和中央角膜厚度。
DMEK术后24个月时，光学区CD从术前的34.4±9.4灰度单位（GSU）降至19.2±2.7 GSU。DSAEK术后24个月时，CD分别从术前的34.0±13.4 GSU降至21.2±2.5 GSU。第3组的平均中央CD为18.1±1.3 GSU。与DSAEK相比，DMEK病例在术后3个月和6个月时中央CD较低（P≤0.012），但术后12个月和24个月时无差异。与健康对照相比，DSAEK在整个术后期间CD值更高（P < 0.001）。DMEK在术后3、6和12个月时与对照相比CD更高，但术后24个月时无差异（P = 0.152）。在每个检查时间点，DMEK术后的BCVA均显著更好。在任何时间点，DMEK和DSAEK之间的内皮细胞密度均无差异。
与DSAEK相比，DMEK在术后前6个月CD较低且BCVA更好。值得注意的是，尽管DMEK和DSAEK术后中期CD达到相似水平，但DMEK术后的BCVA仍显著更好。
