Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.
Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands.
Br J Ophthalmol. 2018 Oct;102(10):1425-1430. doi: 10.1136/bjophthalmol-2017-311398. Epub 2018 Jan 17.
BACKGROUND/AIM: To assess the clinical outcome of the first series of Quarter-Descemet membrane endothelial keratoplasty (Quarter-DMEK), a potential hybrid technique between 'descemetorhexis only' and conventional, circular DMEK.
Prospective interventional case series at a tertiary referral centre. Twelve eyes of 12 patients with central Fuchs endothelial corneal dystrophy underwent Quarter-DMEK, that is, transplantation of one quadrant of a full-diameter DMEK graft, and were evaluated for best-corrected visual acuity (BCVA), endothelial cell density (ECD) and complications up to 6 months postoperatively.
At 6 months postoperatively, all eyes reached a BCVA of ≥20/40 (≥0.5), 11/12 (92%) of ≥20/25 (≥0.8) and 6/12 (50%) of ≥20/20 (≥1.0). Mean central ECD decreased from 2867 (±161) cells/mm before to 1255 (±514) cells/mm at 1 month, 1058 (±455) cells/mm at 3 months and 968 (±427) cells/mm at 6 months after surgery. Rebubbling was performed in 4/12 eyes (33%) within the first two months.
Quarter-DMEK may be a feasible procedure that allows for visual outcomes similar to conventional, circular DMEK. The relatively large drop in ECD within the first month may have resulted from more extensive endothelial cell migration and/or measurement error (at the graft edges). If longer-term outcomes would resemble those of conventional DMEK, Quarter-DMEK may potentially quadruple the availability of endothelial grafts.
背景/目的：评估第一代 Quarter-Descemet 膜内皮角膜移植术（Quarter-DMEK）的临床效果，这是一种“仅撕Descemet 膜”和传统环形 DMEK 之间的潜在混合技术。
在一个三级转诊中心进行的前瞻性干预性病例系列研究。12 例 12 只眼患有中央型 Fuchs 内皮角膜营养不良，接受了 Quarter-DMEK 治疗，即移植一个全直径 DMEK 移植物的一个象限，并在术后 6 个月内评估最佳矫正视力（BCVA）、内皮细胞密度（ECD）和并发症。
术后 6 个月，所有眼睛均达到≥20/40（≥0.5）的 BCVA，11/12（92%）的≥20/25（≥0.8）和 6/12（50%）的≥20/20（≥1.0）。中央 ECD 平均值从术前的 2867（±161）个细胞/mm 下降到术后 1 个月的 1255（±514）个细胞/mm、3 个月的 1058（±455）个细胞/mm 和 6 个月的 968（±427）个细胞/mm。在最初的两个月内，有 4/12 只眼（33%）需要重新打气。
Quarter-DMEK 可能是一种可行的手术方法，可获得与传统环形 DMEK 相似的视力结果。第一个月内 ECD 相对较大的下降可能是由于更广泛的内皮细胞迁移和/或测量误差（在移植物边缘）所致。如果长期结果类似于传统的 DMEK，那么 Quarter-DMEK 可能会使内皮移植物的可用性增加四倍。
