Cornea Research Foundation of America, Indianapolis, Indiana.
Price Vision Group, Indianapolis, Indiana.
Ophthalmology. 2018 Oct;125(10):1508-1514. doi: 10.1016/j.ophtha.2018.03.050. Epub 2018 May 3.
To determine whether the reduced risk of immunologic rejection with Descemet membrane endothelial keratoplasty (DMEK) results in a 5-year survival advantage relative to Descemet stripping endothelial keratoplasty (DSEK) and to determine whether matching the donor and recipient sex affects the rejection episode and graft survival rates.
Retrospective cohort study.
Patients with Fuchs' endothelial corneal dystrophy treated with DSEK or DMEK.
This study reviewed 2017 consecutive cases (1312 DSEK and 705 DMEK) performed by 13 surgeons between 2003 and 2012 and included the surgeons' first cases. Survival rates were calculated by Kaplan-Meier analysis.
Immunologic rejection episodes, graft failure or replacement for any reason, and endothelial cell loss.
The 5-year rejection episode rate was lower with DMEK (2.6% vs. 7.9% with DSEK, relative risk, 0.29; 95% confidence interval, 0.16-0.53) despite early reduction of topical corticosteroids in 25% of the DMEK cases. African Americans (n = 46) had a higher risk of rejection episodes than other races (relative risk, 4.4; 95% confidence interval, 2.0-9.6). The cumulative 5-year survival rate was 93% with DSEK and DMEK (P = 0.86). Forty-four DMEK and 69 DSEK grafts failed or were replaced within 5 years, but only 1 DMEK and 4 DSEK failures followed a rejection episode. Rejection episodes increased endothelial cell loss (P = 0.004) but were not a significant risk factor for graft failure within 5 years (P = 0.90). The mean 5-year endothelial cell loss was similar between DMEK (48%±19%) and DSEK (47%±19%) (P = 0.22). Graft rejection episode and survival rates were not significantly influenced by whether the sex of the donor matched that of the recipient (rejection episodes: P = 0.07 for female recipients and P = 0.33 for male recipients; graft survival: P = 0.67 for female recipients and P = 0.17 for male recipients).
Five-year graft survival was similar between DMEK and DSEK. Although DMEK had a significantly lower risk of immunologic rejection, rejection episodes rarely resulted in graft failure within 5 years with either procedure. Sex matching the donor and recipient provided no survival advantage with DSEK or DMEK.
确定与 Descemet 撕囊内皮角膜移植术（DSEK）相比，Descemet 膜内皮角膜移植术（DMEK）降低免疫排斥风险是否会带来 5 年存活率优势，并确定供受者性别匹配是否会影响排斥事件和移植物存活率。
回顾性队列研究。
接受 Fuchs 内皮角膜营养不良的 DSEK 或 DMEK 治疗的患者。
本研究回顾了 2003 年至 2012 年间 13 位外科医生进行的 2017 例连续病例（1312 例 DSEK 和 705 例 DMEK），包括外科医生的首例病例。通过 Kaplan-Meier 分析计算存活率。
免疫排斥事件、移植物失败或因任何原因更换以及内皮细胞丢失。
尽管 25%的 DMEK 病例早期减少了局部皮质类固醇的使用，但 DMEK 的 5 年排斥事件发生率仍较低（2.6% vs. DSEK 的 7.9%，相对风险，0.29；95%置信区间，0.16-0.53）。非裔美国人（n=46）的排斥事件风险高于其他种族（相对风险，4.4；95%置信区间，2.0-9.6）。DSEK 和 DMEK 的累积 5 年存活率均为 93%（P=0.86）。44 例 DMEK 和 69 例 DSEK 移植物在 5 年内失败或更换，但只有 1 例 DMEK 和 4 例 DSEK 失败与排斥事件有关。排斥事件增加了内皮细胞丢失（P=0.004），但在 5 年内并不是移植物失败的显著危险因素（P=0.90）。DMEK（48%±19%）和 DSEK（47%±19%）的平均 5 年内皮细胞丢失相似（P=0.22）。供受者性别匹配对排斥事件和存活率没有显著影响（排斥事件：女性受者 P=0.07，男性受者 P=0.33；移植物存活率：女性受者 P=0.67，男性受者 P=0.17）。
DMEK 和 DSEK 的 5 年移植物存活率相似。尽管 DMEK 的免疫排斥风险显著降低，但两种手术 5 年内排斥事件很少导致移植物失败。供受者性别匹配在 DSEK 或 DMEK 中均未提供生存优势。
