Department of Ophthalmology, University Hospital of Tübingen, Tübingen, Baden-Württemberg, Germany.
Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Baden-Württemberg, Germany.
Graefes Arch Clin Exp Ophthalmol. 2021 Jul;259(7):1907-1914. doi: 10.1007/s00417-021-05152-w. Epub 2021 Mar 15.
To better assess clinical trajectories of patients with or without ocular comorbidity after Descemet membrane endothelial keratoplasty.
To report on the outcomes of eyes with differing starting conditions following surgery.
Retrospective study at a University Eye Hospital.
361 eyes separated into group 1 (n=229; eyes with endothelial disease only) and group 2 (n=132; eyes with additional ocular comorbid conditions, such as herpetic eye disease 18/132 (13.6%), glaucoma 16/132 (12.1%), dry age-related macular degeneration 14/132 (10.6%), epiretinal membranes 10/132 (7.6%), and wet age-related macular degeneration 9/132 (6.8%)).
Consecutive eyes that underwent Descemet membrane endothelial keratoplasty over a follow-up period of up to 7 years at a tertiary referral center were reviewed. Main outcome measures were best-corrected visual acuity, postoperative complications, graft survival, central corneal thickness, and endothelial cell density.
Postoperative best-corrected visual acuity at year 1 improved in both groups significantly (Wilcoxon signed rank test: group 1, p =.002; .63 to .23 logMAR; group 2, p <.001; 1.15 to .87 logMAR) with a group difference in favor of group 1 (p =.009, Mann-Whitney-Wilcoxon). A decrease of the endothelial cell density and central corneal thickness was noted at postoperative year 1 for both groups (paired t-tests (group 1, p <.001; group 2, p =.045) and paired t-tests (group 1, p <.001; group 2, p =.003). Complications were less common, and graft longevity was superior in group 1.
Eyes with different starting conditions might experience a visual improvement and benefit from surgery. Descemet membrane endothelial keratoplasty is a valid treatment for endothelial disorders in manifold of eyes. Further long-term studies are required.
更好地评估接受 Descemet 膜内皮角膜移植术后伴有或不伴有眼合并症患者的临床轨迹。
报告手术前后不同起始条件下的结果。
大学眼科医院的回顾性研究。
361 只眼分为 1 组（n=229；仅内皮疾病眼）和 2 组（n=132；有其他眼部合并症，如疱疹性眼病 18/132（13.6%）、青光眼 16/132（12.1%）、干性年龄相关性黄斑变性 14/132（10.6%）、视网膜内膜 10/132（7.6%）和湿性年龄相关性黄斑变性 9/132（6.8%））。
回顾性分析在三级转诊中心接受 Descemet 膜内皮角膜移植术的连续眼，随访时间长达 7 年。主要观察指标为最佳矫正视力、术后并发症、移植物存活率、中央角膜厚度和内皮细胞密度。
两组患者术后 1 年最佳矫正视力均显著提高（Wilcoxon 符号秩检验：组 1，p=.002；.63 至.23 logMAR；组 2，p<.001；1.15 至.87 logMAR），组间差异有利于组 1（p=.009，Mann-Whitney-Wilcoxon）。两组术后 1 年内皮细胞密度和中央角膜厚度均下降（配对 t 检验（组 1，p<.001；组 2，p=.045）和配对 t 检验（组 1，p<.001；组 2，p=.003）。组 1 的并发症较少，移植物存活率较高。
不同起始条件的眼可能会经历视力提高并受益于手术。Descemet 膜内皮角膜移植术是治疗多种眼内内皮疾病的有效方法。需要进一步的长期研究。
