《Descemet 膜内皮角膜移植术与超薄 DSAEK 在 Descemet 内皮厚度比较试验中的角膜高阶像差：一项随机临床试验》
Corneal Higher-Order Aberrations in Descemet Membrane Endothelial Keratoplasty versus Ultrathin DSAEK in the Descemet Endothelial Thickness Comparison Trial: A Randomized Clinical Trial.
机构信息
Casey Eye Institute, Oregon Health and Science University, Portland, Oregon.
Francis I. Procter Foundation, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
出版信息
Ophthalmology. 2019 Jul;126(7):946-957. doi: 10.1016/j.ophtha.2019.02.007. Epub 2019 Feb 16.
PURPOSE
To compare corneal higher-order aberrations (HOA) after ultrathin Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK).
DESIGN
Patient- and outcome-masked randomized controlled clinical trial.
PARTICIPANTS
Patients with damaged or diseased endothelium from Fuchs endothelial dystrophy or pseudophakic bullous keratopathy who were good candidates for DMEK or ultrathin DSAEK.
METHODS
Corneal anterior and posterior surface HOA were measured with Scheimpflug imaging before surgery and at 3, 6, and 12 months after surgery. HOA after ultrathin DSAEK and DMEK were compared; correlation was performed between best spectacle-corrected visual acuity (BSCVA) and HOA at each time point.
MAIN OUTCOME MEASURES
Higher-order aberrations of the anterior and posterior cornea, expressed as the root mean square deviation from a best fit sphere reference surface.
RESULTS
At 3, 6, and 12 months after surgery, the posterior corneal surface had significantly less coma (P ≤ 0.003) and total HOA (P ≤ 0.001) in DMEK compared with ultrathin DSAEK (4.0- and 6.0-mm OZ). Posterior trefoil (P ≤ 0.034), secondary astigmatism (P ≤ 0.042), and tetrafoil (P ≤ 0.045) were lower in DMEK than ultrathin DSAEK at 3, 6, or 12 months (either 4.0- or 6.0-mm OZ). There were no significant differences in anterior surface HOA between DMEK and ultrathin DSAEK at any post-surgical time. Compared with baseline, total posterior HOA was increased (P ≤ 0.036) in ultrathin DSAEK at 3, 6, and 12 months, in contrast to DMEK, where it was decreased (P ≤ 0.044) at 6 and 12 months (4.0- or 6.0-mm OZ, or both). At 6 and 12 months, posterior corneal total HOA correlated with BSCVA (ρ ≤ 0.635, P ≤ 0.001; 4.0- and 6.0-mm OZ). There were no moderate or strong correlations between anterior or combined corneal surface HOA at any time point after surgery.
CONCLUSIONS
Descemet membrane endothelial keratoplasty results in less posterior corneal HOA compared with ultrathin DSAEK. Descemet membrane endothelial keratoplasty decreases and ultrathin DSAEK increases posterior corneal HOA compared with presurgical values. Total posterior corneal HOA correlates with 6- and 12-month postoperative visual acuity and may account for the better visual acuity observed after DMEK.
目的
比较超薄撕囊法（DSAEK）与去内皮的角膜基质内镶嵌术（DMEK）术后角膜高阶像差（HOA）。
设计
患者及结局设盲的随机对照临床试验。
参与者
患有 Fuchs 内皮营养不良或假性囊泡性角膜病变导致的受损或患病内皮的患者，适合进行 DMEK 或超薄 DSAEK。
方法
在术前及术后 3、6、12 个月，采用 Scheimpflug 成像仪测量角膜前、后表面 HOA。比较超薄 DSAEK 和 DMEK 的 HOA；比较各时间点最佳矫正视力（BCVA）与 HOA 的相关性。
主要观察指标
角膜前、后表面 HOA，用均方根偏离最佳拟合球面参考表面表示。
结果
术后 3、6、12 个月，DMEK 的后角膜表面彗差（P≤0.003）和总 HOA（P≤0.001）明显低于超薄 DSAEK（4.0- 和 6.0-mm OZ）。术后 3、6、12 个月，DMEK 的后三叶草（P≤0.034）、次要散光（P≤0.042）和四叶草（P≤0.045）低于超薄 DSAEK（4.0- 和 6.0-mm OZ）。术后任何时间点，DMEK 的前表面 HOA 均无显著差异。与基线相比，超薄 DSAEK 在术后 3、6、12 个月时后总 HOA 增加（P≤0.036），而 DMEK 在后 6 和 12 个月时降低（P≤0.044）（4.0- 和 6.0-mm OZ 或两者均）。术后 6、12 个月，后角膜总 HOA 与 BCVA 相关（ρ≤0.635，P≤0.001；4.0- 和 6.0-mm OZ）。术后任何时间点，前表面或联合角膜表面 HOA 之间均无中度或高度相关性。
结论
与超薄 DSAEK 相比，去内皮的角膜基质内镶嵌术可导致后角膜 HOA 减少。与术前相比，去内皮的角膜基质内镶嵌术降低后角膜 HOA，而超薄 DSAEK 则增加后角膜 HOA。后总角膜 HOA 与术后 6、12 个月的视力相关，可能解释了 DMEK 术后更好的视力。
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