Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany.
Klin Monbl Augenheilkd. 2021 Oct;238(10):1101-1107. doi: 10.1055/a-1517-4518. Epub 2021 Jul 26.
To evaluate the results and complications of Descemet membrane endothelial keratoplasty (DMEK) in previously vitrectomized eyes.
Retrospective study of 35 eyes that had undergone DMEK, due to Fuchs endothelial corneal dystrophy (FECD), at our department with a follow-up after 6 months postoperatively. We compared the intraoperative procedure, complications, and results of DMEK between 14 previously vitrectomized pseudophakic eyes (group 1) and a control group of 21 pseudophakic non-vitrectomized eyes (group 2).
The unfolding time (in minutes) was significantly longer in group 1 than in group 2 (10.5 ± 6.4 vs. 3.2 ± 1.5, p < 0.01). A single re-bubbling was needed in 8 patients in group 1 (57.1%) and in 3 patients in group 2 (14.2%) (p < 0.01). Repeated re-bubbling (≥ 1 time) was performed in only 5 patients of group 1 (35.7%). There was significant postoperative improvement in best-corrected visual acuity (BCVA, in LogMAR) in both groups (p = 0.04 in group 1 and p < 0.01 in group 2). The central corneal thickness (CCT, in µm) did not differ significantly between the two groups preoperatively (p = 0.4) or postoperatively (p = 0.1). However, the CCT decreased significantly postoperatively in both groups (p < 0.01 in both groups). The postoperative endothelial cell density (ECD in cell/mm²) was significantly lower in group 1 than in group 2 (p = 0.03).
DMEK in previously vitrectomized eyes presents a surgical challenge, which requires special, and sometimes unpredictable, intraoperative maneuvers, but good functional and morphological results can be achieved. The use of the endothelial Descemet membrane lamellae (EDML) of older donors might be recommended to facilitate the intraoperative unfolding process.
评估已行玻璃体切割术的眼行后弹力层内皮角膜移植术（DMEK）的效果和并发症。
回顾性研究，2016 年至 2018 年，我科对 35 例 Fuchs 内皮角膜营养不良患者行 DMEK，术后随访 6 个月。将 14 例已行玻璃体切割术的白内障术后眼（1 组）与 21 例未行玻璃体切割术的白内障术后眼（2 组）行术中操作、并发症及效果进行比较。
1 组展开时间（分钟）显著长于 2 组（10.5±6.4 比 3.2±1.5，p<0.01）。1 组 8 例（57.1%）患者需单次再注气，2 组 3 例（14.2%）患者需再注气（p<0.01）。1 组仅 5 例（35.7%）患者需重复再注气（≥1 次）。两组术后最佳矫正视力（BCVA，LogMAR）均显著改善（1 组 p=0.04，2 组 p<0.01）。两组术前（p=0.4）及术后（p=0.1）中央角膜厚度（CCT，µm）均无显著差异。两组术后均显著降低（两组均 p<0.01）。1 组术后内皮细胞密度（ECD，细胞/mm²）显著低于 2 组（p=0.03）。
已行玻璃体切割术的眼行 DMEK 术存在手术挑战，需要特殊且有时不可预测的术中操作，但可获得良好的功能和形态学效果。推荐使用较老供体的内皮 Descemet 膜瓣（EDML），以促进术中展开过程。
