Fajgenbaum Mark A P, Kopsachilis Nick, Hollick Emma J
King's College Hospital, London, UK.
Eye (Lond). 2018 Oct;32(10):1629-1635. doi: 10.1038/s41433-018-0152-x. Epub 2018 Jun 19.
To report surgical outcomes and endothelial cell density (ECD) trends up to 2 years post-operatively in the first cohort of eyes undergoing Descemet's membrane endothelial keratoplasty (DMEK) for low-to-moderate risk indications at our UK centre. Tight corneal sutures were used to ensure high intraoperative pressure from intracameral air for 10-min and to maintain a good post-operative air fill. Outcomes were compared to a prior series at our unit of similar eyes having Descemet's stripping endothelial keratoplasty (DSEK).
Retrospective, interventional series. Inclusions: all DMEKs with a minimum of 1-month follow-up.
prior glaucoma surgery, penetrating keratoplasty or anterior chamber lens.
88 DMEKs met inclusion. Median follow-up: 332 days. Main indication: Fuchs dystrophy (90%).
re-bubbling 2%, primary failure 6%, retinal detachment 2%, rejection 3%. At 3 months, BCVA ≥6/6 and ≥6/9 were 67% and 86%, respectively. Graft survival at both 1 and 2 years was 94 ± 2%. Mean(±SD) cell-loss at 1 month, 3 months, 6 months, 12 months and 24 months: 30 ± 15%, 29 ± 16%, 33 ± 17%, 35 ± 17% and 48 ± 16%, respectively. Compared to a prior series at our unit of 210 low-to-moderate risk DSEKs, cell loss was lower for DMEK at all time-points (p < 0.001) through to 12 months but was not statistically different at 24 months. Mixed-modelling of ECD over time demonstrated the convergence of DMEK and DSEK curves by 2 years.
DMEK using tissue from UK eye-banks resulted in high survival and excellent visual acuity. ECD through 1 year was superior to DSEK in a similar cohort. Our low re-bubble rate (2%) may be attributable to use of intracameral air at temporarily elevated intraocular pressure.
报告在英国中心首批因低至中度风险适应证接受Descemet膜内皮角膜移植术（DMEK）的患者术后2年内的手术结果及内皮细胞密度（ECD）变化趋势。术中使用紧密的角膜缝线以确保前房内空气维持10分钟的高眼压，并保持良好的术后空气填充。将结果与本单位之前一组接受Descemet膜剥脱内皮角膜移植术（DSEK）的类似患者进行比较。
回顾性、干预性系列研究。纳入标准：所有接受DMEK且至少随访1个月的患者。
既往有青光眼手术、穿透性角膜移植术或前房型人工晶状体植入史。
88例患者符合纳入标准。中位随访时间：332天。主要适应证：Fuchs角膜内皮营养不良（90%）。
再次注气2%，原发性失败6%，视网膜脱离2%，排斥反应3%。术后3个月时，最佳矫正视力（BCVA）≥6/6和≥6/9的患者分别为67%和86%。1年和2年时的移植物存活率均为94±2%。术后1个月、3个月、6个月、12个月和24个月时的平均（±标准差）细胞丢失率分别为30±15%、29±16%、33±17%、35±17%和48±16%。与本单位之前一组210例低至中度风险的DSEK患者相比，DMEK在所有时间点直至12个月时的细胞丢失率均较低（p<0.001）但在24个月时无统计学差异。ECD随时间的混合模型显示，DMEK和DSEK曲线在2年时趋于一致。
使用英国眼库组织进行的DMEK手术具有高存活率和极佳的视力。在类似队列中，DMEK术后1年内的ECD优于DSEK。我们较低的再次注气率（2%）可能归因于在眼压暂时升高时使用前房内空气。
