Pereira Nicolas Cesário, Gomes José Álvaro Pereira, Moriyama Aline Silveira, Chaves Luis Fernando, Forseto Adriana Dos Santos
Department of Ophthalmology, Sorocaba's Ophthalmological Hospital, Sorocaba Eye Bank, Sorocaba, São Paulo, Brazil.
Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
Cornea. 2019 Jul;38(7):806-811. doi: 10.1097/ICO.0000000000001957.
To describe the outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed by cornea fellows during their initial learning curve.
This prospective study included the first consecutive series of 53 DMEK surgeries performed by 14 corneal fellows at Sorocaba's Ophthalmological Hospital. Best spectacle-corrected visual acuity, endothelial cell density (ECD), and complications were evaluated.
Of the eyes without ocular comorbidities and with complete visual acuity measurements, 97% of 33 eyes achieved a best spectacle-corrected visual acuity of ≥20/40 in 6 months. The mean (SD) preoperative donor ECD was 2453 (361) cells/mm, and at 6 months postoperatively, the in vivo mean ECD (SD) was found to be 1300 (587) cells/mm, an average loss of 47%. Preparation of the DMEK graft by the cornea fellows was successful in all cases. There were 9 eyes (17%) that experienced partial graft detachment requiring rebubbling. A total of 3 eyes (5.7%) failed to clear the cornea, all of which were managed with successful secondary endothelial keratoplasty. None of the eyes experienced pupillary block.
Establishing DMEK in a fellowship program was successful with the supervision of an experienced DMEK surgeon. Even without the facility of a prestripped DMEK graft by an eye bank and with no backup tissue, no surgery was canceled because of graft preparation failure. Good visual outcomes were achieved with satisfactory ECD at 6-month follow-up, with an acceptable complication rate. Even the 3 eyes that failed to clear the cornea evolved well after secondary endothelial keratoplasty by the cornea fellows.
描述角膜专科住院医师在初始学习曲线阶段进行的Descemet膜内皮角膜移植术（DMEK）的结果。
这项前瞻性研究纳入了索罗卡巴眼科医院14名角膜专科住院医师连续进行的首批53例DMEK手术。评估最佳矫正视力、内皮细胞密度（ECD）和并发症。
在无眼部合并症且视力测量完整的眼中，33只眼中有97%在6个月时达到最佳矫正视力≥20/40。术前供体ECD的平均（标准差）为2453（361）个细胞/mm²，术后6个月，体内平均ECD（标准差）为1300（587）个细胞/mm²，平均损失47%。角膜专科住院医师制备DMEK植片在所有病例中均成功。有9只眼（17%）发生部分植片脱离，需要再次注入空气。共有3只眼（5.7%）角膜未能清亮，所有这些眼均通过二次内皮角膜移植术成功处理。所有眼均未发生瞳孔阻滞。
在经验丰富的DMEK外科医生的监督下，在专科培训项目中开展DMEK手术是成功的。即使没有眼库预剥离DMEK植片的设备且没有备用组织，也没有因植片制备失败而取消手术。在6个月随访时获得了良好的视力结果，ECD令人满意，并发症发生率可接受。即使是3只角膜未能清亮的眼，在角膜专科住院医师进行二次内皮角膜移植术后也恢复良好。
