Sorkin Nir, Showail Mahmood, Einan-Lifshitz Adi, Boutin Tanguy, Borovik Armand, Kreimei Mohammad, Rosenblatt Amir, Chan Clara C, Rootman David S
Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Cornea. 2018 Jun;37(6):678-681. doi: 10.1097/ICO.0000000000001564.
To analyze the outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with previous Descemet stripping automated endothelial keratoplasty (DSAEK).
This retrospective interventional case series included 26 eyes (26 patients) that underwent DMEK to replace a previous DSAEK graft with at least 6 months of follow-up. The outcome measures were indications for surgery, best spectacle-corrected visual acuity (BSCVA), endothelial cell density, rebubbling rate, rejection, and failure.
Patient age was 71.9 ± 12.6 years. The average follow-up time after DMEK was 15.1 ± 10.6 months. Indications for DMEK were DSAEK graft failure (69%) and a DSAEK suboptimal visual outcome (31%). BSCVA of the entire cohort (n = 26) improved from 1.33 ± 0.78 logMAR preoperatively to 1.04 ± 0.78 and 1.06 ± 0.89 logMAR at 6 months postoperatively and at the last follow-up, respectively (P = 0.019 and P = 0.033). BSCVA among eyes without visual comorbidities (n = 13) improved from 0.84 ± 0.50 logMAR preoperatively to 0.55 ± 0.47 and 0.51 ± 0.49 logMAR at 6 months postoperatively and at final follow-up, respectively (P = 0.023 for both). Of these eyes, 84.6% had improvement in BSCVA at 6 months postoperatively and at last follow-up. In the subgroup of 8 eyes with DMEK for suboptimal visual outcomes after DSAEK, BSCVA improved from 0.81 ± 0.44 to 0.52 ± 0.35 logMAR at final follow-up (P = 0.024). When excluding eyes with visual comorbidities, BSCVA of this subgroup (n = 5) improved from 0.54 ± 0.32 to 0.36 ± 0.25 logMAR at final follow-up (P = 0.038). BSCVA of this subgroup at 6 months postoperatively was not significantly different from preoperative BSCVA, when including visual comorbidities (n = 8, 0.75 ± 0.60 logMAR, P = 0.79) and when excluding visual comorbidities (n = 5, 0.40 ± 0.28 logMAR, P = 0.621). Endothelial cell density decreased from 2753 ± 307 cells/mm to 1659 ± 655 cells/mm 6 months after surgery (39.7% loss, P = 0.005). Three eyes (11.5%) required rebubbling, and 5 eyes (19.2%) had secondary graft failure at 2 to 20 months.
DMEK is effective for replacing previous DSAEK not only for graft failure but also for suboptimal visual outcomes.
分析在曾接受过Descemet膜剥除自动内皮角膜移植术（DSAEK）的眼中进行Descemet膜内皮角膜移植术（DMEK）的效果。
本回顾性干预病例系列研究纳入了26只眼（26例患者），这些患者接受了DMEK手术以替换先前的DSAEK移植片，且至少随访6个月。观察指标包括手术指征、最佳矫正视力（BSCVA）、内皮细胞密度、再次注气率、排斥反应和手术失败情况。
患者年龄为71.9±12.6岁。DMEK术后平均随访时间为15.1±10.6个月。DMEK的手术指征为DSAEK移植片失败（69%）和DSAEK术后视力未达最佳（31%）。整个队列（n = 26）的BSCVA术前为1.33±0.78 logMAR，术后6个月和最后一次随访时分别改善至1.04±0.78和1.06±0.89 logMAR（P = 0.019和P = 0.033）。无视力合并症的眼（n = 13）的BSCVA术前为0.84±0.50 logMAR，术后6个月和最终随访时分别改善至0.55±0.47和0.51±0.49 logMAR（两者P均 = 0.023）。在这些眼中，84.6%在术后6个月和最后一次随访时BSCVA有所改善。在因DSAEK术后视力未达最佳而接受DMEK的8只眼亚组中，最终随访时BSCVA从0.81±0.44改善至0.52±0.35 logMAR（P = 0.024）。排除有视力合并症的眼后，该亚组（n = 5）的BSCVA在最终随访时从0.54±0.32改善至0.36±0.25 logMAR（P = 0.038）。该亚组术后6个月的BSCVA，在纳入有视力合并症的眼时（n = 8，0.75±）
