Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Center for Molecular Medicine (CMMC), University of Cologne, Cologne, Germany.
Acta Ophthalmol. 2021 Dec;99(8):e1326-e1333. doi: 10.1111/aos.14835. Epub 2021 May 4.
To compare two surgical treatment options for acute corneal hydrops in keratoconus: Mini-DMEK versus predescemetal sutures.
Sixteen patients were treated by either Mini-Descemet membrane endothelial keratoplasty (Mini-DMEK) (n = 7, group 1) or predescemetal sutures (n = 9, group 2) early after onset of acute hydrops. Visual acuity, maximum corneal thickness (SD-OCT) in the affected oedematous area, complications and recurrence rates were retrospectively compared between both groups. Measurements were taken immediately preoperatively as well as 1 day, 1 week and 1 month postoperatively (Table 1).
Both groups showed reductions in corneal thickness and increased visual acuity shortly after surgery. In group 1 (average age 33 years ± 7 years), the best corrected visual acuity (BCVA) increased from logMAR 1.65 ± 0.7 before Mini-DMEK to logMAR 0.93 ± 0.6 30 days after Mini-DMEK (p = 0.046). During that period, maximum corneal thickness decreased from 1159 ± 338 µm before surgery to 531 ± 75 µm after Mini-DMEK (p = 0.046). Patients from group 2 (average age 34 ± 10 years) had a BCVA of logMAR 1.59 ± 0.8 which increased to logMAR 0.97 ± 0.5 (p = 0.014) 30 days after surgery. At the same time, the preoperative maximum corneal thickness decreased from 1439 ± 272 µm to 476 ± 162 µm (p = 0.014). There was no difference in corneal thickness or BCVA one month after the surgical intervention between both groups (p = 0.394 and p = 0.871).
Both techniques, Mini-DMEK and predescemetal sutures, are effective in the treatment of an acute hydrops in keratoconus. Mini-DMEK appears to be beneficial in large DM tears.
比较两种治疗圆锥角膜急性角膜水肿的手术方法：微创板层角膜内皮移植术（Mini-DMEK）与预置缝线。
16 例患者分别接受 Mini-Descemet 膜内皮角膜移植术（Mini-DMEK）（n=7，第 1 组）或预置缝线（n=9，第 2 组）治疗，于急性水肿发作后早期进行治疗。回顾性比较两组之间的视力、受影响水肿区域的最大角膜厚度（SD-OCT）、并发症和复发率。表 1 中列出了术前即刻以及术后 1 天、1 周和 1 个月的测量值。
两组患者的角膜厚度均在术后短期内降低，视力均有所提高。在第 1 组（平均年龄 33 岁±7 岁）中，最佳矫正视力（BCVA）从 Mini-DMEK 术前的 logMAR 1.65±0.7 提高到术后 30 天的 logMAR 0.93±0.6（p=0.046）。在此期间，最大角膜厚度从术前的 1159μm±338μm 降至 Mini-DMEK 术后的 531μm±75μm（p=0.046）。第 2 组（平均年龄 34 岁±10 岁）患者的 BCVA 为 logMAR 1.59±0.8，术后 30 天提高至 logMAR 0.97±0.5（p=0.014）。与此同时，术前最大角膜厚度从 1439μm±272μm 降至 476μm±162μm（p=0.014）。两组术后 1 个月时的角膜厚度和 BCVA 无差异（p=0.394 和 p=0.871）。
Mini-DMEK 和预置缝线两种技术在治疗圆锥角膜急性角膜水肿方面均有效。Mini-DMEK 似乎对大的 DM 撕裂有益。
