预先载入与非预先载入的 Descemet 膜内皮角膜移植术的一年临床结果比较。

One-Year Clinical Outcomes of Preloaded Descemet Membrane Endothelial Keratoplasty Versus Non-Preloaded Descemet Membrane Endothelial Keratoplasty.

机构信息

Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institution, Massachusetts Eye and Ear Infirmary, Boston, MA.

出版信息

Cornea. 2021 Mar 1;40(3):311-319. doi: 10.1097/ICO.0000000000002430.

DOI:10.1097/ICO.0000000000002430

PMID:32740011

Abstract

PURPOSE

To compare the one-year outcomes of preloaded Descemet membrane endothelial keratoplasty (pDMEK) and non-preloaded DMEK (n-pDMEK) in patients with Fuchs endothelial corneal dystrophy (FECD).

METHODS

This retrospective comparative cohort study consecutively included 68 eyes with Fuchs endothelial corneal dystrophy who underwent either pDMEK (n = 38) or n-pDMEK (n = 30) performed by cornea fellows with an experienced surgeon between 2016 and 2018 at the Massachusetts Eye and Ear Infirmary. Exclusion criteria were previous surgery (other than uncomplicated cataract surgery) and any documented evidence of macular or other corneal diseases. Corrected distance visual acuity (CDVA), central corneal thickness, intraocular pressure, patient characteristics, postprocessing endothelial cell count, donor graft data, and complications were compared.

RESULTS

CDVA showed similar results for pDMEK (0.12 ± 0.11 logarithm of the minimal angle of resolution [LogMAR]) and n-pDMEK (0.13 ± 0.13 LogMAR) (P = 0.827). Sixty-six percent of the pDMEK eyes and 57% of the n-pDMEK eyes achieved a VA of ≥0.1 LogMAR, and 95% and 97%, respectively, achieved a CDVA ≥0.3 LogMAR. The preoperative central corneal thickness of pDMEK and n-pDMEK (644 ± 62.2 μm, 660.5 ± 56.2 μm) decreased significantly after surgery (525.1 ± 43.6 μm, 526.5 ± 45.2 μm, P < 0.001), with no difference between groups (P = 0.840). The postprocessing endothelial cell count did not differ between pDMEK (2959.2 ± 182.9 cells/mm2) and n-pDMEK (2939.3 ± 278.7 cells/mm2) (P = 0.484). Complication rates were comparable with just the rebubbling performed in a minor procedure room showing a lower rate for pDMEK (13.16%) compared with n-pDMEK (33.33%) (P < 0.045).

CONCLUSIONS

One-year clinical outcomes were similar between pDMEK and n-pDMEK procedures, rendering eye bank-prepared pDMEK tissues a useful tool in the treatment of endothelial dysfunction.

摘要

目的

比较预先加载的 Descemet 膜内皮角膜移植术（pDMEK）和非预先加载的 DMEK（n-pDMEK）治疗 Fuchs 内皮角膜营养不良（FECD）患者的一年疗效。

方法

本回顾性对照队列研究连续纳入了 2016 年至 2018 年间在马萨诸塞眼耳医院由角膜研究员与一位经验丰富的外科医生共同进行 pDMEK（n=38）或 n-pDMEK（n=30）的 68 只 FECD 患者。排除标准为既往手术（除简单白内障手术外）和任何记录的黄斑或其他角膜疾病证据。比较校正后的视力（CDVA）、中央角膜厚度、眼内压、患者特征、后处理内皮细胞计数、供体移植物数据和并发症。

结果

pDMEK 的 CDVA 结果与 n-pDMEK 相似（0.12±0.11 最小分辨角对数 [LogMAR]）（P=0.827）。66%的 pDMEK 眼和 57%的 n-pDMEK 眼获得了≥0.1 LogMAR 的视力，分别有 95%和 97%的眼获得了≥0.3 LogMAR 的 CDVA。pDMEK 和 n-pDMEK 的术前中央角膜厚度（644±62.2μm，660.5±56.2μm）术后显著降低（525.1±43.6μm，526.5±45.2μm，P<0.001），两组之间无差异（P=0.840）。pDMEK（2959.2±182.9 个细胞/mm2）和 n-pDMEK（2939.3±278.7 个细胞/mm2）的后处理内皮细胞计数无差异（P=0.484）。并发症发生率相似，仅在小手术间进行再灌流的 pDMEK 发生率较低（13.16%），而 n-pDMEK 发生率较高（33.33%）（P<0.045）。