*Corneal and External Diseases Unit, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; and †Institute of Ophthalmology, University College London (IoO UCL), London, United Kingdom.
Cornea. 2021 Apr;40(4):420-424. doi: 10.1097/ICO.0000000000002636.
To compare the survival rate 1 year after Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic eyes versus combined phacoemulsification and DMEK (triple-DMEK).
Retrospective, interventional, consecutive case series. From all DMEKs performed from January 1, 2017, to June 30, 2018, we selected those performed in pseudophakic eyes (pseudophakic DMEK) and those that underwent triple-DMEK. We compared the survival rate 1 year after surgery between both groups and between the Fuchs endothelial dystrophy (FED) cases in both groups, plus the FED cases versus the pseudophakic bullous keratopathy (PBK) cases in the pseudophakic DMEK group. Second, we compared rebubbling rates and the influence of the use of gas or corneal sutures on rebubbling and dislocation rates.
A total of 329 eyes were included (218 eyes pseudophakic DMEK and 111 eyes triple-DMEK). The survival rate at 1 year was 79.8% and 90%, respectively (P = 0.03). When only FED cases were included (133 pseudophakic DMEK and 108 triple-DMEK), no significant difference was found (87.9% vs. 90.7%, P = 0.59). Within the pseudophakic DMEK group, the survival rate was higher in FED cases (87.8%) compared with PBK cases (66.6%) (P = 0.0001). Rebubbling rates were 21.1% (pseudophakic DMEK) and 17.1% (triple-DMEK) (P = 0.39). The use of gas versus air or placing corneal sutures did not seem to influence the rebubbling (P = 0.64 and P = 0.13, respectively) or dislocation rates (P = 0.71 and P = 0.53, respectively).
In the FED cases, performing phacoemulsification before DMEK or doing a combined procedure did not seem to affect the rebubbling or survival rate up to 1 year postoperatively. PBK was associated with a higher failure rate compared with that of FED.
比较 1 年后行去内皮角膜内皮移植术(DMEK)治疗后白内障术后无晶状体眼与白内障超声乳化术联合 DMEK(三联 DMEK)的生存率。
回顾性、干预性、连续病例系列研究。我们从 2017 年 1 月 1 日至 2018 年 6 月 30 日期间所有行 DMEK 的患者中选择了白内障术后无晶状体眼(白内障术后 DMEK)和三联 DMEK 的患者。我们比较了两组患者术后 1 年的生存率,以及两组中 Fuchs 内皮营养不良(FED)患者的生存率,同时比较了白内障术后 DMEK 组中 FED 患者与白内障术后单纯疱性角膜病变(PBK)患者的生存率。其次,我们比较了再灌洗率,以及使用气体或角膜缝线对再灌洗和脱位率的影响。
共纳入 329 只眼(218 只白内障术后 DMEK,111 只三联 DMEK)。术后 1 年的生存率分别为 79.8%和 90%(P = 0.03)。仅纳入 FED 患者(白内障术后 DMEK 组 133 例,三联 DMEK 组 108 例)时,无显著差异(87.9% vs. 90.7%,P = 0.59)。在白内障术后 DMEK 组中,FED 患者的生存率(87.8%)高于 PBK 患者(66.6%)(P = 0.0001)。再灌洗率分别为 21.1%(白内障术后 DMEK)和 17.1%(三联 DMEK)(P = 0.39)。使用气体与空气或放置角膜缝线似乎并不影响再灌洗(P = 0.64 和 P = 0.13)或脱位率(P = 0.71 和 P = 0.53)。
在 FED 患者中,DMEK 前行白内障超声乳化术或行联合手术似乎并不影响术后 1 年的再灌洗或生存率。与 FED 相比,PBK 与更高的失败率相关。