Malyugin B E, Izmaylova S B, Malyutina E A, Antonova O P, Gelyastanov A M
S. Fyodorov Eye Microsurgery Federal State Institution, 59a Beskudnikovskiy blvd, Moscow, Russian Federation, 127486.
Vestn Oftalmol. 2017;133(6):16-22. doi: 10.17116/oftalma2017133616-22.
Poor visual function associated with Fuchs endothelial corneal dystrophy (FECD) is one of the main indications for keratoplasty. Reports of successful visual rehabilitation of patients with spontaneous or scheduled removal of the Descemet's membrane and the endothelium or donor material adhesion failure, suggest this research direction perspective.
to evaluate the potential as well as clinical and functional outcomes of phacoemulsification with central circular descemetorhexis in patients with Fuchs endothelial corneal dystrophy.
A total of 19 patients aged 51-84 years were included. The preoperative best corrected visual acuity averaged 0.32±0.19, endothelial cells density - 629.6±336.9 cells/mm, and central corneal pachymetry - 587.8±44.8 µm. After phacoemulsification with IOL implantation, a 4 mm tap was created from the epithelial side of the cornea. Central circular descemetorhexis was done using a microhook. The membrane was removed with microforceps.
On day 1, there was central corneal edema matching the circular defect in the Descemet's membrane. As many as 26.3% of patients demonstrated rapid responses to the treatment, which implies that corneal transparency and visual improvement were achieved by the end of the first month after surgery. In other 26.3% of patients, full corneal transparency was not achieved and, therefore, endothelium transplantation had to be performed. The main group included 12 patients. At 12 months, the best corrected visual acuity was 0.66±0.29, central pachymetry - 569.27±63.74 µm, endothelial cells density - 634.00±170.41 cells/mm.
In 63.8% of patients, visual rehabilitation was achieved without endothelial transplantation, which provides new prospects for tissue-saving technologies in patients with endothelial corneal dystrophy.
与富克斯内皮性角膜营养不良（FECD）相关的视力低下是角膜移植的主要指征之一。关于自发性或计划性去除后弹力层和内皮或供体材料黏附失败的患者成功实现视力康复的报道，提示了这一研究方向的前景。
评估在富克斯内皮性角膜营养不良患者中进行中央环形后弹力层撕除的超声乳化术的潜力以及临床和功能结果。
共纳入19例年龄在51至84岁之间的患者。术前最佳矫正视力平均为0.32±0.19，内皮细胞密度为629.6±336.9个/mm，中央角膜厚度为587.8±44.8 µm。在进行超声乳化联合人工晶状体植入术后，从角膜上皮侧制作一个4 mm的切口。使用微型钩进行中央环形后弹力层撕除。用微型镊子移除该膜。
术后第1天，中央角膜出现与后弹力层圆形缺损相匹配的水肿。多达26.3%的患者对治疗反应迅速，这意味着在术后第一个月末实现了角膜透明和视力改善。在另外26.3%的患者中，未实现完全角膜透明，因此不得不进行内皮移植。主要组包括12例患者。在12个月时，最佳矫正视力为0.66±0.29，中央角膜厚度为569.27±63.74 µm，内皮细胞密度为634.00±170.41个/mm。
63.8%的患者在未进行内皮移植的情况下实现了视力康复，这为内皮性角膜营养不良患者的组织保存技术提供了新的前景。
