Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont..
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.
Can J Ophthalmol. 2018 Oct;53(5):510-517. doi: 10.1016/j.jcjo.2017.11.017. Epub 2018 May 7.
To report and analyze the clinical outcomes of the first 250 cases of Descemet membrane endothelial keratoplasty (DMEK).
A retrospective case series was conducted on the first 250 DMEK cases. The cohort included eyes with previous trabeculectomy, pre-existing glaucoma drainage device, and previous vitrectomy. Outcomes measures were best spectacle-corrected visual acuity (BSCVA), endothelial cell loss (ECL), episodes of rejection, detachment, rebubbling rate, and the need for repeat transplantation. Subgroup analysis was performed between eyes with different etiologies and between different DMEK injectors.
The median BSCVA increased from 0.6 [0.4, 1.3] logMAR (Snellen equivalent, 20/80) before surgery to 0.3 [0.2, 0.5] logMAR (Snellen equivalent, 20/40) 6 months after DMEK (p < 0.001). The median ECL at 6 months after surgery was 26.1%. Thirty-nine eyes (15.6%) had graft detachment involving more than one third of the graft and required rebubbling. Two eyes (0.8%) had a graft rejection episode. Fifteen eyes (6%) had graft failure for which 13 eyes (5.2%) had repeat DMEK, 1 eye (0.4%) had repeat Descemet stripping automated endothelial keratoplasty (DSAEK), and 1 eye (0.4%) had repeat penetrating keratoplasty (PKP). Fuchs' patients and failed PKP patients gained more vision at 6 months post-DMEK compared with other etiologies (pseudophakic bullous keratopathy and failed DSAEK) (p < 0.001).
Our data suggest that DMEK is a safe and effective procedure with excellent visual outcomes. DMEK can be done in association with other co-morbidities such as post-trabeculectomy, glaucoma drainage device, previous vitrectomy, and failed corneal grafts with a good prognosis.
报告并分析首例 250 例去内皮角膜内皮移植术（DMEK）的临床结果。
对首例 250 例 DMEK 病例进行回顾性病例系列研究。该队列包括既往小梁切除术、预存青光眼引流装置和既往玻璃体切除术的眼。观察指标为最佳矫正视力（BSCVA）、内皮细胞丢失（ECL）、排斥反应、脱离、再充气率和重复移植的需要。在不同病因和不同 DMEK 注射器之间进行了亚组分析。
手术后 6 个月，中位数 BSCVA 从手术前的 0.6 [0.4, 1.3] logMAR（Snellen 等效值，20/80）增加至 0.3 [0.2, 0.5] logMAR（Snellen 等效值，20/40）（p<0.001）。术后 6 个月时，中位数 ECL 为 26.1%。39 只眼（15.6%）发生了超过三分之一移植片的移植物脱离，需要再充气。2 只眼（0.8%）发生移植物排斥反应。15 只眼（6%）发生移植物失功，其中 13 只眼（5.2%）行再次 DMEK，1 只眼（0.4%）行再次 Descemet 撕囊自动角膜内皮移植术（DSAEK），1 只眼（0.4%）行再次穿透性角膜移植术（PKP）。与其他病因（假性囊泡性角膜病变和 DSAEK 失败）相比，Fuchs 患者和 PKP 失败患者在 DMEK 后 6 个月获得更多视力（p<0.001）。
我们的数据表明，DMEK 是一种安全有效的手术，具有良好的视觉效果。DMEK 可以与其他合并症一起进行，如小梁切除术后、青光眼引流装置、既往玻璃体切除术以及失败的角膜移植，预后良好。
