Department of Ophthalmology, Campus Virchow-Klinikum, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany.
Graefes Arch Clin Exp Ophthalmol. 2020 Nov;258(11):2459-2465. doi: 10.1007/s00417-020-04852-z. Epub 2020 Jul 23.
Unfolding and attachment of the posterior donor lamella may be the most challenging part in Descemet membrane endothelial keratoplasty (DMEK) procedure. We investigated the correlation of the difficulty degrees of this step to the postoperative clinical outcome 6 years after surgery.
One hundred sixty-nine consecutive DMEKs between September 2012 and August 2013 at the Charité-University Medicine Berlin were graded prospectively into 4 groups according to their grade of difficulty in unfolding and attachment of the graft lamella. Postoperative visual acuity, endothelial cell density, and rate of graft failure were measured after 1 year, after 2 years, and after 6 years and analyzed according to their grading group.
Visual acuity improved significantly in all groups and did not differ significantly between the grading groups at any time point postoperatively. There was a significant decrease of endothelial cell density in all groups with a significantly higher endothelial cell loss in group IV compared with the other groups within the first 24 months after surgery. The graft failure rate was significantly higher in eyes graded III and IV than in groups I and II (p = 0.012).
Although the endothelial cell loss and the graft failure rate increase significantly with a more difficult graft unfolding and attachment, DMEK surgery is a promising procedure with a good long-term postoperative outcome. A direct manipulation of the graft lamella for unfolding and centering by cannula or forceps should be avoided if possible to reduce the risk of an increased endothelial cell loss and a higher graft failure rate.
NCT02020044.
在后弹力层内皮角膜移植术（DMEK）中，供体后弹力层的展开和附着可能是最具挑战性的部分。我们研究了该步骤的难度等级与术后 6 年临床结果之间的相关性。
2012 年 9 月至 2013 年 8 月期间，在柏林夏洛蒂医科大学进行了 169 例连续的 DMEK，根据供体瓣展开和附着的难度程度将其前瞻性地分为 4 组。术后 1 年、2 年和 6 年分别测量术后视力、内皮细胞密度和移植物失败率，并根据分级组进行分析。
所有组的视力均显著提高，且术后任何时间点的分级组之间差异均无统计学意义。所有组的内皮细胞密度均显著下降，术后前 24 个月，第 IV 组与其他组相比，内皮细胞丢失明显更高。第 III 组和第 IV 组的移植物失败率明显高于第 I 组和第 II 组（p = 0.012）。
尽管展开和附着供体瓣较困难时，内皮细胞丢失和移植物失败率显著增加，但 DMEK 手术是一种有前途的术式，具有良好的长期术后效果。如果可能的话，应避免使用套管或镊子直接操作供体瓣以展开和居中，以降低内皮细胞丢失增加和移植物失败率增加的风险。
NCT02020044。
