Jansen Christina, Zetterberg Madeleine
Department of Ophthalmology, Region Västra Götaland, Sahlgrenska University Hospital, Mölndal, Sweden.
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Clin Ophthalmol. 2021 Mar 2;15:909-921. doi: 10.2147/OPTH.S289730. eCollection 2021.
To compare clinical outcome and complications of Descemet stripping automated keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK).
This is a retrospective study of the first consecutive cases of DSAEK and DMEK performed by a single surgeon at a tertiary referral centre. Best-corrected visual acuity (BCVA), postoperative complications, rate of rebubbling and regraft were the main outcome measures.
The study included 241 eyes, 116 subjected to DSAEK and 125 to DMEK. Fuchs endothelial dystrophy (FED) was the predominant diagnosis in both groups. Mean BCVA at all follow-ups up to 2 years was in favour of DMEK. Median BCVA (decimal) at 1 year was 0.4 (0.13-0.60; interquartile range) for the DSAEK and 0.8 (0.6-1.0) for the DMEK group, p<0.001. Preoperative BCVA in the DSAEK group was lower than in DMEK. There was no significant difference in visual improvement between groups at 1 year postoperatively. The most common postoperative complication in both groups was a pupillary block with high intraocular pressure, 27% and 34% respectively. This was not affected by the presence of an iridectomy/iridotomy. In the DMEK group, gas provided significantly better adherence than air (p=0.020). Rebubbling for partial/total detachment was performed in 7% (DSAEK) and 11% (DMEK) of cases, p=0.361. Regraft within 2 years was performed in 13% of eyes in the DSAEK and 17% in the DMEK group, p=0.450. No case of graft rejection occurred.
Both DSAEK and DMEK provide overall satisfying outcome and the two techniques do not differ significantly in postoperative pupillary block, detachment rate, early graft failure or graft rejection. However, differences at baseline may have influenced or obscured potential differences. In DMEK procedures, gas seems to facilitate early graft adherence.
比较深板层角膜内皮移植术（DSAEK）和角膜后弹力层内皮移植术（DMEK）的临床疗效和并发症。
这是一项回顾性研究，纳入了由一名外科医生在三级转诊中心连续完成的首批DSAEK和DMEK病例。主要观察指标为最佳矫正视力（BCVA）、术后并发症、气泡再形成率和再次移植率。
该研究共纳入241只眼，其中116只接受了DSAEK手术，125只接受了DMEK手术。两组的主要诊断均为Fuchs内皮营养不良（FED）。在长达2年的所有随访中，平均BCVA显示DMEK更具优势。DSAEK组1年时的BCVA中位数（小数）为0.4（0.13 - 0.60；四分位间距），DMEK组为0.8（0.6 - 1.0），p<0.001。DSAEK组术前BCVA低于DMEK组。术后1年时两组间视力改善无显著差异。两组最常见的术后并发症均为瞳孔阻滞伴高眼压，分别为27%和34%。这不受虹膜切除术/虹膜切开术的影响。在DMEK组中，气体提供的黏附效果明显优于空气（p = 0.020）。DSAEK组和DMEK组分别有7%和11%的病例因部分/完全脱离进行了气泡再形成操作，p = 0.361。DSAEK组和DMEK组分别有13%和17%的眼在2年内进行了再次移植，p = 0.450。未发生移植排斥病例。
DSAEK和DMEK均能提供总体令人满意的疗效，两种技术在术后瞳孔阻滞、脱离率、早期移植失败或移植排斥方面无显著差异。然而，基线差异可能影响或掩盖了潜在差异。在DMEK手术中，气体似乎有助于早期移植片黏附。
