Mimouni Michael, Sorkin Nir, Slomovic Jacqueline, Kisilevsky Eli, Mednick Zale, Cohen Eyal, Trinh Tanya, Santaella Gisella, Chan Clara C, Rootman David S, Slomovic Allan R
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Curr Eye Res. 2021 Sep;46(9):1283-1290. doi: 10.1080/02713683.2021.1892150. Epub 2021 Mar 4.
Vitrectomized eyes pose a technical challenge when performing endothelial keratoplasty (EK). The aim of the study was to compare outcomes of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) in complex eyes undergoing pars plana vitrectomy (PPV) prior to or during surgery.
This retrospective study included consecutive eyes that underwent pars plana infusion-assisted DMEK or pull-through DSAEK which underwent PPV prior to or during the EK at a tertiary center. Included were eyes with at least 1-year follow-up. The main outcome measures were best-corrected visual acuity (BCVA) and serious adverse events.
Fifty-two eyes (n = 52) with a mean follow-up time of 24.6 ± 7.4 months were included. Both groups were similar in terms of baseline characteristics although the DMEK group had a significantly larger proportion of Fuchs' patients ( = .009). There was no significant difference in postoperative logMAR BCVA between groups at each visit ( > .05 for all). There was a significantly higher proportion of overall serious adverse events (50.0% versus 15.4%, = .02), retinal detachments (19.2% versus 0.0%, = .05) and cystoid macular edema (23.1% versus 0.0%, = .02) following DMEK. Graft detachment occurred more often following DMEK (53.9% versus 11.5%, = .001) with no significant difference in rebubbling rates (23.1% versus 11.5%, = .27).
A significant and similar improvement in BCVA was achieved following DMEK and DSAEK in complex vitrectomized eyes. Patients should be advised regarding the higher rates of potential serious complications associated with a pars plana infusion DMEK in this situation.
在进行内皮角膜移植术（EK）时，玻璃体切除后的眼睛存在技术挑战。本研究的目的是比较在手术前或手术期间接受玻璃体切除术（PPV）的复杂眼睛中，后弹力层内皮角膜移植术（DMEK）和后弹力层剥除自动内皮角膜移植术（DSAEK）的效果。
这项回顾性研究纳入了在三级中心接受经扁平部灌注辅助DMEK或牵拉式DSAEK的连续病例，这些病例在EK之前或期间接受了PPV。纳入至少随访1年的眼睛。主要观察指标是最佳矫正视力（BCVA）和严重不良事件。
纳入52只眼睛，平均随访时间为24.6±7.4个月。两组在基线特征方面相似，尽管DMEK组中Fuchs患者的比例显著更高（P =.009）。每次随访时，两组术后logMAR BCVA均无显著差异（所有P>.05）。DMEK术后总体严重不良事件的比例显著更高（50.0%对15.4%，P =.02），视网膜脱离（19.2%对0.0%，P =.05）和黄斑囊样水肿（23.1%对0.0%，P =.02）。DMEK术后移植片脱离更常见（53.9%对11.5%，P =.001），复泡率无显著差异（23.1%对11.5%，P =.27）。
在复杂的玻璃体切除眼中，DMEK和DSAEK术后BCVA均有显著且相似的改善。在这种情况下，应告知患者经扁平部灌注DMEK潜在严重并发症的发生率较高。
