Sorkin Nir, Mednick Zale, Einan-Lifshitz Adi, Trinh Tanya, Santaella Gisella, Telli Alexandre, Chan Clara C, Rootman David S
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
Ophthalmology Department, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Cornea. 2019 Jul;38(7):812-816. doi: 10.1097/ICO.0000000000001956.
To evaluate 3-year outcomes of femtosecond laser-assisted Descemet membrane endothelial keratoplasty (F-DMEK) compared with manual Descemet membrane endothelial keratoplasty (M-DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD).
A retrospective, interventional study, including eyes with FECD and cataract that underwent either F-DMEK or M-DMEK combined with cataract extraction at either the Toronto Western Hospital or Kensington Eye Institute, and that had at least 18 months' follow-up was conducted.
complicated anterior segments, previous vitrectomy, previous keratoplasty, corneal opacity, or any other visually significant ocular comorbidity.
Included were 16 eyes of 15 patients in the F-DMEK group (average follow-up 33.0 ± 9.0 months) and 45 eyes of 40 patients in the M-DMEK group (average follow-up 32.0 ± 7.0 months). There were no issues with the creation of femtosecond descemetorhexis (in the F-DMEK group)-all descemetorhexis cuts were complete. Best spectacle-corrected visual acuity improvement did not differ significantly between the groups at 1, 2, and 3 years (P = 0.849, P = 0.465 and P = 0.936, respectively). Rates of significant detachment in F-DMEK and M-DMEK were 1 of 16 eyes (6.25%) and 16 of 45 eyes (35.6%) (P = 0.027). Rebubbling rates were 1 of 16 eyes (6.25%) and 15 of 45 eyes (33.3%) (P = 0.047). Cell-loss rates following F-DMEK and M-DMEK were 26.8% and 36.5% at 1 year (P = 0.042), 30.5% and 42.3% at 2 years (P = 0.008), 37% and 47.5% at 3 years (P = 0.057), respectively. Graft failure rate was 0% in F-DMEK and 8.9% in M-DMEK (all were primary failures; P = 0.565).
F-DMEK showed good efficacy with reduced detachment, rebubble, and cell-loss rates, compared with M-DMEK.
评估飞秒激光辅助Descemet膜内皮角膜移植术（F-DMEK）与手动Descemet膜内皮角膜移植术（M-DMEK）治疗Fuchs内皮性角膜营养不良（FECD）患者的3年疗效。
进行一项回顾性干预研究，纳入在多伦多西部医院或肯辛顿眼科研究所接受F-DMEK或M-DMEK联合白内障摘除术且患有FECD和白内障的眼睛，并进行至少18个月的随访。
前段复杂、既往玻璃体切除术、既往角膜移植术、角膜混浊或任何其他具有明显视觉影响的眼部合并症。
F-DMEK组纳入15例患者的16只眼（平均随访33.0±9.0个月），M-DMEK组纳入40例患者的45只眼（平均随访32.0±7.0个月）。飞秒撕除Descemet膜（F-DMEK组）过程中无问题——所有Descemet膜撕除均完整。两组在1年、2年和3年时最佳矫正视力改善情况无显著差异（P分别为0.849、0.465和0.936）。F-DMEK组和M-DMEK组的显著脱离率分别为16只眼中的1只（6.25%）和45只眼中的16只（35.6%）（P = 0.027）。再气泡形成率分别为16只眼中的1只（6.25%）和45只眼中的15只（33.3%）（P = 0.047）。F-DMEK组和M-DMEK组术后1年的细胞丢失率分别为26.8%和36.5%（P = 0.042），2年时分别为30.5%和42.3%（P = 0.008），3年时分别为37%和47.5%（P = 0.057）。F-DMEK组的移植物失败率为0%，M-DMEK组为8.9%（均为原发性失败；P = 0.565）。
与M-DMEK相比，F-DMEK显示出良好的疗效，其脱离、再气泡形成和细胞丢失率均降低。
