a Department of Ophthalmology , Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health , Berlin , Germany.
b Berlin Institute of Health (BIH) , Berlin , Germany.
Curr Eye Res. 2019 Feb;44(2):147-153. doi: 10.1080/02713683.2018.1538459. Epub 2018 Oct 29.
The purpose of this study is to identify predictors for the best-corrected visual acuity (BCVA), central corneal thickness (CCT), and the endothelial cell density (ECD) after primary Descemet's membrane endothelial keratoplasty (DMEK).
In a prospective observational study, 108 eyes with Fuchs' endothelial dystrophy underwent a primary DMEK. Preoperative data, histologic parameters from host's Descemet's membrane, and follow-up data of the first eye were analyzed in regard to BCVA, CCT, and ECD, 12 months after surgery.
Overall, 12 months postoperative, the BCVA improved to 0.11 ± 0.11 logMAR, the CCT declined to 529 ± 42 µm, and the ECD measured 1675 ± 418 cells/mm. A significant influence of the preoperative CCT on postoperative BCVAs and CCTs was observed (r = 0.299, p = 0.014 and r = 0.507, p < 0.001, respectively). Especially eyes with a CCT <625 µm demonstrated a better BCVA (0.05 ± 0.07 logMAR) than eyes with a CCT ≥625 µm (0.13 ± 0.11 logMAR, p = 0.002). Furthermore, the identification of eyes with an early visual restitution was possible by considering follow-up data of the first eye. A preoperative CCT ≥625 µm was also sensitive to identify eyes with a persistent corneal swelling. The anterior banded layer thickness, which was obtained histologically, correlated to the preoperative CCT and the frequency of graft detachments (r = 0.601, p = 0.023 and r = 0.652, p = 0.041, respectively). Furthermore, a graft's baseline ECD ≤2100 cells/mm was found to be a risk factor for an ECD deterioration under 1000 cells/mm (1.8% vs. 15.8%, p = 0.020).
Simple clinical parameters, such as the preoperative CCT, the course of visual restitution of the first eye, and the graft's baseline ECD, are efficient predictors for relevant outcome parameters after DMEK and therefore may be used for stratification. Furthermore, our findings indicate that a DMEK should be performed in eyes with Fuchs' endothelial corneal dystrophy, if possible, before the CCT exceeds 625 µm to maintain good clinical results.
本研究旨在确定原发性 Descemet 膜内皮角膜移植术（DMEK）后最佳矫正视力（BCVA）、中央角膜厚度（CCT）和角膜内皮细胞密度（ECD）的预测因素。
在一项前瞻性观察研究中，108 只患有 Fuchs 角膜内皮营养不良的眼睛接受了原发性 DMEK 手术。分析了手术前数据、供体 Descemet 膜的组织学参数以及术后 12 个月第一只眼的随访数据，以评估 BCVA、CCT 和 ECD。
总体而言，术后 12 个月，BCVA 提高至 0.11±0.11logMAR，CCT 下降至 529±42µm，ECD 测量值为 1675±418 个细胞/mm。术前 CCT 对术后 BCVA 和 CCT 有显著影响（r=0.299，p=0.014 和 r=0.507，p<0.001）。特别是 CCT<625µm 的眼睛的 BCVA（0.05±0.07logMAR）明显优于 CCT≥625µm 的眼睛（0.13±0.11logMAR，p=0.002）。此外，通过考虑第一只眼的随访数据，可以识别出早期视力恢复的眼睛。术前 CCT≥625µm 也能敏感地识别出持续角膜肿胀的眼睛。组织学获得的前带状层厚度与术前 CCT 和移植物脱离的频率相关（r=0.601，p=0.023 和 r=0.652，p=0.041）。此外，发现移植片的基线 ECD≤2100 个细胞/mm 是 ECD 下降至 1000 个细胞/mm 以下的危险因素（1.8% vs. 15.8%，p=0.020）。
简单的临床参数，如术前 CCT、第一只眼视力恢复的过程和移植物的基线 ECD，是 DMEK 后相关结局参数的有效预测因素，因此可用于分层。此外，我们的研究结果表明，如果可能的话，患有 Fuchs 角膜内皮营养不良的眼睛应在 CCT 超过 625µm 之前进行 DMEK，以保持良好的临床效果。
