Janson Ben J, Terveen Daniel C, Benage Matthew J, Zimmerman M Bridget, Mixon David C, Aldrich Benjamin T, Skeie Jessica M, Schmidt Gregory A, Reed Cynthia R, Goins Kenneth M, Greiner Mark A
Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA.
Am J Ophthalmol Case Rep. 2019 Jul 9;15:100512. doi: 10.1016/j.ajoc.2019.100512. eCollection 2019 Sep.
To compare Descemet membrane endothelial keratoplasty (DMEK) outcomes using nondiabetic grafts in diabetic and nondiabetic recipients.
All eyes that underwent DMEK between February 2013 and October 2016 (follow-up ≥3 months, without prior keratoplasty) were included. Recipients were divided into diabetic (insulin dependent [IDDM] or noninsulin dependent [NIDDM]) and nondiabetic groups. Main outcome measures included postoperative visual acuity, rebubble procedure rates, and graft failure rates.
Of 334 eyes (243 subjects) included for analysis, 63 eyes (18.8%) were from diabetic recipients. At each timepoint, best-corrected visual acuity trended lower for IDDM recipients compared to NIDDM and nondiabetic recipients. There were no statistically significant differences in rebubble rates of diabetic compared to nondiabetic recipients (20.6% vs. 12.9%, p = 0.17), or IDDM compared to nondiabetic recipients (27.3% vs. 12.9%, p = 0.08; hazard ratio 2.26). Overall, 13 grafts (3.9%) failed (mean follow-up, 565 days; range, 90-1293 days). Graft failures did not differ between diabetic and nondiabetic recipients (4.0% vs. 4.9%, p = 0.15) regardless of subgroup (p = 0.36).
DMEK provides excellent outcomes for patients with and without diabetes. DMEK outcomes were excellent with improvements in visual acuity and low rates of graft failure. Our findings were unable to determine differences between rebubble procedure rates but do emphasize the need for further research using stratified groups based on diabetes severity.
比较在糖尿病和非糖尿病受者中使用非糖尿病供体进行Descemet膜内皮角膜移植术（DMEK）的效果。
纳入2013年2月至2016年10月期间接受DMEK手术的所有眼睛（随访≥3个月，未行过角膜移植术）。受者分为糖尿病组（胰岛素依赖型[IDDM]或非胰岛素依赖型[NIDDM]）和非糖尿病组。主要观察指标包括术后视力、再次注气手术率和移植失败率。
纳入分析的334只眼睛（243名受试者）中，63只眼睛（18.8%）来自糖尿病受者。在每个时间点，与NIDDM和非糖尿病受者相比，IDDM受者的最佳矫正视力呈下降趋势。糖尿病受者与非糖尿病受者的再次注气率（20.6%对12.9%，p = 0.17），或IDDM受者与非糖尿病受者的再次注气率（27.3%对12.9%，p = 0.08；风险比2.26）无统计学显著差异。总体而言，13片移植物（3.9%）失败（平均随访565天；范围90 - 1293天）。糖尿病和非糖尿病受者之间的移植物失败率无差异（4.0%对4.9%，p = 0.15），无论亚组如何（p = 0.36）。
DMEK为糖尿病和非糖尿病患者均提供了良好的效果。DMEK术后视力改善且移植失败率低，效果良好。我们的研究结果无法确定再次注气手术率之间的差异，但确实强调了需要根据糖尿病严重程度进行分层分组的进一步研究。
