Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Cornea. 2021 Oct 1;40(10):1253-1257. doi: 10.1097/ICO.0000000000002723.
To evaluate the outcome of phakic and pseudophakic eyes treated by Descemet membrane endothelial keratoplasty (DMEK) versus DMEK combined with cataract surgery (triple DMEK).
Retrospective cohort study based on the prospective Cologne DMEK data base. This study is a single-center analysis of 62 eyes undergoing phakic (age mean ± SD 52 ± 6.43), 518 eyes undergoing pseudophakic (73.5 ± 8.57), and 557 eyes undergoing triple DMEK (67.93 ± 8.57). Outcome measures were changes in best spectacle-corrected visual acuity (BSCVA), central corneal thickness, endothelial cell density (ECD), rebubbling rates within the first year after surgery, and the need for cataract surgery within the first 2 years after phakic DMEK.
The preoperative BSCVA (mean ± SD; logarithm of the minimum angle of resolution) was 0.30 ± 0.22 in the phakic, 0.63 ± 0.45 in the pseudophakic, and 0.44 ± 0.30 in the triple DMEK group (P < 0.001), which changed to 0.09 ± 0.12, 0.14 ± 0.1, and 0.1 ± 0.1 (P < 0.001) 1 year after surgery, respectively. There was no difference in central corneal thickness (P = 0.929) and endothelial cell density (P = 0.606) 1 year postoperatively. Rebubbling rates in DMEK using SF6 20% for anterior chamber tamponade were not significantly different (P = 0.839). After phakic DMEK, 40% of eyes underwent cataract surgery within the second year. However, there was a high loss to follow-up in this group.
Phakic and triple DMEK procedures tend to have a better 1-year BSCVA than pseudophakic DMEK, with no differences in all other parameters analyzed. However, patients from the pseudophakic DMEK group were older and already had worse BSCVA before surgery.
评估行去内皮角膜内皮移植术（DMEK）的有晶状体眼和无晶状体眼与行 DMEK 联合白内障手术（三联 DMEK）的疗效。
这是一项基于前瞻性科隆 DMEK 数据库的回顾性队列研究。本研究为单中心分析，纳入 62 例行有晶状体眼手术（年龄均值±标准差 52±6.43 岁）、518 例行无晶状体眼手术（73.5±8.57 岁）和 557 例行三联 DMEK 手术（67.93±8.57 岁）患者。观察指标包括最佳矫正视力（BSCVA）、中央角膜厚度、内皮细胞密度（ECD）的变化，术后 1 年内的复发性气泡、以及有晶状体眼 DMEK 术后 2 年内白内障手术的需求。
术前 BSCVA（均值±标准差；最小分辨角对数）在有晶状体眼组为 0.30±0.22，无晶状体眼组为 0.63±0.45，三联 DMEK 组为 0.44±0.30（P＜0.001），术后 1 年分别改善至 0.09±0.12、0.14±0.10 和 0.10±0.10（P＜0.001）。术后 1 年三组间中央角膜厚度（P=0.929）和 ECD（P=0.606）无差异。SF6 20%用于前房填塞的 DMEK 复发性气泡率无显著差异（P=0.839）。有晶状体眼 DMEK 术后 2 年内 40%的眼行白内障手术，但该组失访率较高。
有晶状体眼和三联 DMEK 手术 1 年 BSCVA 优于无晶状体眼 DMEK，但分析的所有其他参数无差异。然而，无晶状体眼 DMEK 组患者年龄较大，术前 BSCVA 较差。
