Department of Ophthalmology, Ospedale Privato "Villa Igea," Forlì, Italy; Istituto Internazionale per Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
Department of Ophthalmology, Ospedale Privato "Villa Igea," Forlì, Italy; Istituto Internazionale per Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy; SS Giovanni e Paolo Hospital, Department of Ophthalmology, Venezia, Italy.
Am J Ophthalmol. 2018 Sep;193:106-113. doi: 10.1016/j.ajo.2018.06.013. Epub 2018 Jun 27.
To evaluate the initial outcomes and complications of Descemet membrane endothelial keratoplasty (DMEK) using donor tissues tri-folded with the endothelium inwards, preloaded at the Eye Bank, and delivered with bimanual pull-through technique.
Prospective, noncomparative, interventional case series.
Setting: Eye bank and tertiary care eye department.
Forty-six consecutive eyes of 41 patients with Fuchs endothelial dystrophy with or without cataract operated between November 2016 and March 2017.
DMEK tissues prepared with SCUBA technique and punched to a diameter of 8.25 mm were preloaded with the endothelium tri-folded inwards in an intraocular lens (IOL) cartridge with a 2.2-mm opening filled with the same tissue culture medium contained in the vial used for shipment to the surgeon. Standardized DMEK was performed as a single procedure (n = 15) or in combination with phacoemulsification and IOL implantation (n = 31) within 48 hours from preparation using a bimanual pull-through technique.
Preparation and surgical times, intraoperative and postoperative complications, best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD), and graft detachment rate.
Preparation time averaged 26.2 ± 4.1 minutes (range 17-36 minutes), while the surgical time from opening of the stoppers to air fill of the anterior chamber never exceeded 9 minutes (range 3-9 minutes). Surgery was uneventful in all cases. Postoperative complications included graft detachment in 9 of 46 cases (19.6%), successfully managed in all cases by single rebubbling within 6 days from surgery, and glaucoma irresponsive to conservative treatment in 1 of 46 cases (2.1%). In all eyes without comorbidities (35 of 40 eyes) BSCVA was 20/25 (0.097 logMAR) or better as early as 3 months after surgery. Six months postoperatively, ECD was available in 24 of 25 eyes with an endothelial cell loss calculated as a percentage of the preoperative value determined at the eye bank (ranging from 2500 to 2800 cells/mm) of 29.5% ± 14.8% (range 8.3%-52.1%).
Delivering a preloaded DMEK tissue, tri-folded with the endothelium inwards, minimizes surgical time and costs without negatively affecting the outcomes of the procedure.
评估使用经眼库预处理并折叠内皮面朝向内的三折叠供体组织，通过双手提拉技术进行的内界膜内皮角膜移植术（DMEK）的初始结果和并发症。
前瞻性、非对照、干预性病例系列研究。
地点：眼库和三级眼科护理部门。
41 名患者的 46 只连续眼，患有 Fuchs 内皮营养不良伴或不伴白内障，于 2016 年 11 月至 2017 年 3 月间接受手术。
使用 SCUBA 技术制备的 DMEK 组织，并以 8.25mm 的直径冲孔，在充满相同组织培养液的眼内透镜（IOL）盒中预载三折叠内皮面朝向内，IOL 盒上有一个 2.2mm 的开口，该培养液与用于运送至外科医生的小瓶中的培养液相同。在准备后的 48 小时内，使用双手提拉技术，将标准化的 DMEK 作为单一程序（n=15）或与超声乳化白内障吸除术和 IOL 植入术（n=31）联合进行。
准备和手术时间、术中及术后并发症、最佳矫正视力（BCVA）、内皮细胞密度（ECD）和移植物脱离率。
准备时间平均为 26.2±4.1 分钟（范围 17-36 分钟），而从打开塞子到前房充气的手术时间从不超过 9 分钟（范围 3-9 分钟）。所有病例的手术均无并发症。术后并发症包括 46 例中的 9 例（19.6%）移植物脱离，所有病例均通过术后 6 天内单次再灌气成功处理，46 例中的 1 例（2.1%）出现对保守治疗无反应的青光眼。在所有无合并症的眼（40 眼中的 35 眼）中，术后 3 个月时的 BCVA 为 20/25（0.097 logMAR）或更好。术后 6 个月时，24 只眼的 ECD 可获得，与术前在眼库确定的内皮细胞丢失率相比，内皮细胞丢失率（2500 至 2800 个细胞/mm）计算为 29.5%±14.8%（范围 8.3%-52.1%）。
提供经预处理并折叠内皮面朝向内的三折叠供体组织，可最大限度地减少手术时间和成本，而不会对手术结果产生负面影响。
