Malyugin B E, Shilova N F, Anisimova N S, Antonova O P
S. Fyodorov Eye Microsurgery Federal State Institution, 59A Beskudnikovsky Blvd., Moscow, Russian Federation, 127486.
Vestn Oftalmol. 2019;135(1):98-103. doi: 10.17116/oftalma201913501198.
Nowadays, endothelial keratoplasty has become an alternative to penetrating keratoplasty (PKP) in the management of corneal endothelial dysfunction. Descemet membrane endothelial keratoplasty (DMEK) is a relatively new corneal transplantation surgery technique suited for patients with endothelial insufficiency, an increasing number of surgeons are learning the graft preparation technique and the surgery itself after seeing its excellent postoperative visual outcomes and faster rehabilitation of patients. DMEK has significant advantages in comparison with automated and manual Descemet Stripping Endothelial Keratoplasty (DSAEK/DSEK) and PKP including lower risk of immunologic graft rejection (1-2%), lower cost of the procedure, and it does not require expensive equipment such as a microkeratome or a femtosecond laser device. Another advantage is that the corneal graft tissue can be used for several recipients - e.g. when the Descemet's membrane and endothelium are used for a patient with endothelial dysfunction of the cornea, the retained stroma and epithelium can be then used for another patient with pathology of these corneal layers. Key problematic issues regarding this surgery are the technical difficulties during graft preparation and during surgery itself, however the majority of surgeons report very good results after gaining some experience. The article reviews latest clinical trials on DMEK and describes its strengths and weaknesses.
如今,在角膜内皮功能障碍的治疗中,内皮角膜移植术已成为穿透性角膜移植术(PKP)的替代方法。Descemet膜内皮角膜移植术(DMEK)是一种相对较新的角膜移植手术技术,适用于内皮功能不全的患者。越来越多的外科医生在看到其出色的术后视觉效果和患者更快康复后,正在学习移植物制备技术和手术本身。与自动和手动Descemet剥脱内皮角膜移植术(DSAEK/DSEK)和PKP相比,DMEK具有显著优势,包括免疫移植物排斥风险较低(1-2%)、手术成本较低,并且不需要诸如微型角膜刀或飞秒激光设备等昂贵设备。另一个优点是角膜移植组织可用于多个接受者——例如,当Descemet膜和内皮用于角膜内皮功能障碍患者时,保留的基质和上皮随后可用于这些角膜层有病变的另一名患者。关于该手术的关键问题是移植物制备和手术过程中的技术困难,然而,大多数外科医生在获得一些经验后报告结果非常好。本文回顾了关于DMEK的最新临床试验,并描述了其优缺点。