Castellucci Massimo, Novara Costanza, Casuccio Alessandra, Cillino Giovannni, Giordano Carla, Failla Valentina, Bonfiglio Vincenza, Vadalà Maria, Cillino Salvatore
Department of Biomedicine, Neurosciences and Advanced Diagnostic, Ophthalmology Section, University of Palermo, 90127 Palermo, Italy.
Department of Health Promotion, Mother Child Care, Internal Medicine and of Excellence, University of Palermo, 90127 Palermo, Italy.
Medicina (Kaunas). 2021 Feb 3;57(2):133. doi: 10.3390/medicina57020133.
The objective of this paper is to compare the visual outcomes and quality of life (QoL) after bilateral ultrathin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK) with bilateral penetrating keratoplasty (PK) for Fuchs' endothelial dystrophy (FED). Retrospective comparative cohort study, including 11 patients with FED who underwent bilateral PK and 13 patients with FED who underwent bilateral UT-DSAEK. All patients were already pseudophakic or had undergone a combined cataract procedure. The main outcomes were corrected distance visual acuity (CDVA) corneal higher-order aberrations (HOAs), contrast sensitivity (CS) and quality of life (QoL). The mean follow-up after the second eye surgery was 32.5 ± 10.2 months in PK and 19.6 ± 8.6 months in UT-DSAEK patients. The CDVA in the UT-DSAEK group was significantly better than in the PK one (0.18 ± 0.07 vs. 0.35 ± 0.16 logMAR, < 0.0001). The mean anterior corneal total HOAs of the central 5 mm were significantly lower in UT-DSAEK eyes than in PK eyes (0.438 ± 0.078 µ and 1.282 ± 0.330 µ respectively, < 0.0001), whilst the mean posterior total HOAs did not differ between groups (0.196 ± 0.056 µ and 0.231 ± 0.089 µ, respectively, = 0.253). The CS was lower at 0.75 and 1.5 cycles/degree in P the K group when compared to the DSAEK one ( = 0.008 and 0.005, respectively). The QoL scores by the NEI RQL-42 test exhibited better values in DSAEK patients in 9 out of 13 scales. Our study confirms that UT-DSAEK provides a better visual function in terms of CDVA and CS, together with lower HOAs, when compared to PK. Hence, the vision-related QoL, binocularly evaluated by the NEI RQL-42 items, indicates a higher satisfaction in UT-DSAEK eyes.
本文的目的是比较双侧超薄Descemet膜剥脱自动内皮角膜移植术（UT-DSAEK）与双侧穿透性角膜移植术（PK）治疗Fuchs内皮营养不良（FED）后的视觉效果和生活质量（QoL）。回顾性比较队列研究，包括11例行双侧PK的FED患者和13例行双侧UT-DSAEK的FED患者。所有患者均已植入人工晶状体或接受了白内障联合手术。主要结局指标为矫正远视力（CDVA）、角膜高阶像差（HOAs）、对比敏感度（CS）和生活质量（QoL）。PK组第二眼手术后的平均随访时间为32.5±10.2个月，UT-DSAEK组为19.6±8.6个月。UT-DSAEK组的CDVA明显优于PK组（分别为0.18±0.07与0.35±0.16 logMAR，<0.0001）。UT-DSAEK眼中央5mm的角膜前表面总HOAs明显低于PK眼（分别为0.438±0.078µ和1.282±0.330µ，<0.0001），而两组间后表面总HOAs无差异（分别为0.196±0.056µ和0.231±0.089µ，P = 0.253）。与DSAEK组相比，PK组在0.75和1.5周期/度时的CS较低（分别为P = 0.008和0.005）。在13个量表中的9个量表上，通过NEI RQL-42测试得到的QoL评分显示DSAEK患者的值更好。我们的研究证实，与PK相比，UT-DSAEK在CDVA和CS方面提供了更好的视觉功能，同时HOAs更低。因此，通过NEI RQL-42项目进行双眼评估的与视力相关的QoL表明，UT-DSAEK眼的满意度更高。
