J Refract Surg. 2021 Feb 1;37(2):119-125. doi: 10.3928/1081597X-20201208-01.
To analyze the incidence of cataract extraction after Descemet membrane endothelial keratoplasty (DMEK) in phakic eyes and to evaluate the effect of phacoemulsification after DMEK on the donor endothelial cell density (ECD).
The clinical data of phakic patients with DMEK were examined. From this cohort, all patients who subsequently underwent phacoemulsification after DMEK were reviewed. Data from a prospectively collected dataset were analyzed, including demographic profile, ECD, corrected distance visual acuity (CDVA), central corneal thickness (CCT), and complications.
From a series of 261 phakic patients with DMEK, 35 eyes (13.4%) required cataract surgery within the mean follow-up period of 54.2 ± 28 months. The mean time from DMEK to phacoemulsification was 18 ± 13 months (range: 3 to 69 months). The probability of cataract extraction after DMEK was 0.06 (95% CI: 0.03 to 0.09) at 1 year and 0.17 (95% CI: 0.12 to 0.22) at 10 years, respectively. ECD decreased from 1,314 ± 524 cells/mm before phacoemulsification to 1,167 ± 443 cells/mm (-11%) at 1 to 6 months postoperatively (P = .333). CDVA improved from 0.27 ± 0.13 logMAR preoperatively to 0.07 ± 0.12 logMAR at 1 to 6 months postoperatively. CCT before phacoemulsification was 532 ± 46 µm and remained stable at 539 ± 56 µm at 1 to 6 months after phacoemulsification. Phacoemulsification did not elicit DMEK graft detachment in any of the eyes studied.
The incidence and 10-year projection of cataract extraction in phakic eyes with DMEK was relatively low. Phacoemulsification after DMEK provided excellent CDVA outcomes, did not induce graft detachment, and was associated with an acceptable decrease in ECD. [J Refract Surg. 2021;37(2):119-125.].
分析后发性白内障在有晶状体眼 Descemet 膜内皮角膜移植术（DMEK）中的发生率，并评估 DMEK 后白内障超声乳化术对供体角膜内皮细胞密度（ECD）的影响。
检查了有晶状体眼 DMEK 患者的临床数据。从该队列中，回顾了所有随后在 DMEK 后接受白内障超声乳化术的患者。对前瞻性收集的数据进行了分析，包括人口统计学特征、ECD、矫正远距视力（CDVA）、中央角膜厚度（CCT）和并发症。
在 261 例有晶状体眼 DMEK 患者中，35 只眼（13.4%）在平均 54.2±28 个月的随访期间需要进行白内障手术。从 DMEK 到白内障超声乳化术的平均时间为 18±13 个月（范围：3 至 69 个月）。DMEK 后白内障摘除的概率分别为 1 年后 0.06（95%可信区间：0.03 至 0.09）和 10 年后 0.17（95%可信区间：0.12 至 0.22）。白内障超声乳化术后 1 至 6 个月，ECD 从术前的 1314±524 个细胞/mm2 降至 1167±443 个细胞/mm2（-11%）（P=0.333）。CDVA 从术前 0.27±0.13 logMAR 提高至术后 1 至 6 个月的 0.07±0.12 logMAR。白内障超声乳化术前 CCT 为 532±46 µm，术后 1 至 6 个月稳定在 539±56 µm。研究中没有一只眼因白内障超声乳化术而出现 DMEK 移植物脱离。
有晶状体眼 DMEK 后白内障的发生率和 10 年预测值相对较低。DMEK 后白内障超声乳化术提供了极好的 CDVA 结果，不会引起移植物脱离，与 ECD 可接受的下降相关。[J Refract Surg. 2021;37(2):119-125.]。
