Department of Ophthalmology, King's College Hospital National Health Service Foundation Trust, Denmark Hill, London, United Kingdom.
Department of Ophthalmology, King's College Hospital National Health Service Foundation Trust, Denmark Hill, London, United Kingdom.
Am J Ophthalmol. 2020 Oct;218:1-6. doi: 10.1016/j.ajo.2020.05.003. Epub 2020 May 11.
This study compared the outcomes after Descemet's membrane endothelial keratoplasty (DMEK) in pseudophakic patients with the outcomes after DMEK combined with cataract surgery (triple-DMEK) in patients with Fuchs' endothelial dystrophy (FED).
Retrospective, single-institution, interventional, consecutive case series.
Outcomes of 114 DMEKs in patients with FED at a minimum of 1-year follow-up were reviewed. A total of 34 eyes (29 patients) were pseudophakic and underwent only DMEK (DMEK-only), and 80 eyes (56 patients) underwent triple-DMEK. Main outcome measurements included endothelial cell loss (ECL), best-corrected visual acuity (BCVA), central corneal thickness (CCT), and complications.
At 1 month, ECL was 25% (±16%) and 35% (±15%) in DMEK-only and triple-DMEK groups, respectively. At 1 year, ECL was 33% (±13%) and 41% (±16%) in DMEK-only and triple-DMEK groups, respectively. There was statistically significantly less ECL after DMEK-only than after triple-DMEK at both 1 month (95% confidence interval [CI]: 1.67-15.02; P = .016) and 1 year (95% CI: 1.06-14.07; P = .034). CCT was significantly lower after DMEK-only than after triple-DMEK at 1 month but not at 1 year. BCVA was excellent and similar in the 2 groups. There were no cases of graft failure. Graft rejection and rebubbling rates were similar in DMEK-only and triple-DMEK groups: rejection occured in 8.8% and 8.75% of cases respectively (P = .50), and rebubbling in 2.9% and 2.5% respectively (P = .44).
Both the DMEK-only and the triple-DMEK groups had low rebubbling rates and good visual outcomes, but the combined triple-DMEK procedure resulted in significantly greater loss of endothelial cells than DMEK-only surgery at both 1 month and 1 year.
本研究比较了后发性白内障患者行单纯后弹力层内皮角膜移植术（DMEK）与 Fuchs 角膜内皮营养不良（FED）患者行三联合 DMEK（DMEK 联合白内障手术）的效果。
回顾性、单中心、干预性、连续病例系列。
对至少随访 1 年的 114 例 FED 患者的 DMEK 结果进行了回顾性分析。共有 34 只眼（29 例）为后发性白内障，仅行 DMEK（单纯 DMEK 组），80 只眼（56 例）行三联合 DMEK。主要观察指标包括内皮细胞丢失（ECD）、最佳矫正视力（BCVA）、中央角膜厚度（CCT）和并发症。
术后 1 个月，单纯 DMEK 组和三联合 DMEK 组的 ECD 分别为 25%（±16%）和 35%（±15%）。术后 1 年，单纯 DMEK 组和三联合 DMEK 组的 ECD 分别为 33%（±13%）和 41%（±16%）。术后 1 个月和 1 年，单纯 DMEK 组的 ECD 明显低于三联合 DMEK 组（95%置信区间[CI]：1.67-15.02；P=0.016 和 95%CI：1.06-14.07；P=0.034）。术后 1 个月，单纯 DMEK 组的 CCT 明显低于三联合 DMEK 组，但术后 1 年时差异无统计学意义。两组的 BCVA 均良好且相似。无移植物失功病例。单纯 DMEK 组和三联合 DMEK 组的移植物排斥和再次抽吸率相似：排斥发生率分别为 8.8%和 8.75%（P=0.50），再次抽吸率分别为 2.9%和 2.5%（P=0.44）。
单纯 DMEK 组和三联合 DMEK 组的再次抽吸率和视力结果均良好，但三联合 DMEK 组在术后 1 个月和 1 年时的内皮细胞丢失明显多于单纯 DMEK 手术。
