Sydney Eye Hospital.
VIROS - Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria.
Curr Opin Ophthalmol. 2019 Jul;30(4):275-285. doi: 10.1097/ICU.0000000000000579.
To summarize the recent literature regarding descemetorhexis stripping without endothelial keratoplasty (DWEK), increasingly referred to as Descemet's stripping only (DSO). To report the characteristic clinical, confocal and histologic findings associated with this procedure.
Reported clearance rates following DSO range from 63 to 100% in recent series, with variation between surgical techniques. Topical Rho-kinase inhibitor has been reported as successfully salvaging failing cases. Its use as an adjuvant to the surgery is gaining widespread adoption with the results of early series now arriving. Apart from a phenotype of central guttata with clear periphery, patient characteristics which determine success remain elusive. Surgical factors affecting success are increasingly well understood, with stromal injury felt to be a retardant to healing. Characteristic clinical signs have been observed and are described herein. Clinical, confocal and light microscopic images are obtained from patients in clinical trials of DSO with ripasudil.
DSO is gaining acceptance as a surgical option for a subset of patients with Fuchs' Dystrophy. The addition of Rho-associated kinase inhibitor appears to improve predictability but further results to this effect must be published and scrutinized.
总结近期关于无内皮角膜移植的撕囊术（Descemetorhexis stripping without endothelial keratoplasty，DWEK），即撕除Descemet 膜（Descemet's stripping only，DSO）的文献，报道与该手术相关的临床、共焦和组织学特征。
近期系列研究报道 DSO 术后的清除率为 63%至 100%，不同手术技术之间存在差异。局部 Rho 激酶抑制剂已被报道可成功挽救失败病例。随着早期系列研究结果的出现，其作为手术辅助剂的应用越来越广泛。除了具有明确周边的中央颗粒状外观外，决定手术成功的患者特征仍难以确定。影响手术成功率的手术因素越来越被了解，认为基质损伤是愈合的障碍。本文描述了在此类接受 ripasudil 的 DSO 临床试验中的患者的典型临床、共焦和光学显微镜图像。
DSO 作为 Fuchs 营养不良患者的一种手术选择正在得到认可。添加 Rho 相关激酶抑制剂似乎可以提高预测性，但必须公布并仔细研究这方面的进一步结果。
