Guindolet Damien, Huynh Odile, Martin Gilles C, Disegni Hugo, Azar Georges, Cochereau Isabelle, Gabison Eric
Ophthalmology-Pr Cochereau, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
Université de Paris, Paris, France.
Br J Ophthalmol. 2023 Apr;107(4):470-475. doi: 10.1136/bjophthalmol-2021-319455. Epub 2021 Nov 8.
To determine the incidence and risk factors of cystoid macular oedema (CMO) following descemet membrane endothelial keratoplasty (DMEK) with or without combined cataract surgery (triple-DMEK).
We reviewed the records of patients who underwent DMEK surgery alone or triple-DMEK performed at the Rothschild Foundation Hospital (Paris, France) between January 2019 and March 2020. Patients with pre-existing CMO observed on the preoperative macular optical coherence tomography (OCT) were excluded. Spectral-domain OCT was performed in patients with postoperative visual impairment. Data regarding comorbidities, intraoperative characteristics and postoperative treatments or complications were collected and analysed. Univariate and multivariate analyses were performed.
Twenty three of 246 eyes (9.36%) developed clinically significant (cs)-CMO after DMEK. Triple-DMEK was not associated with a higher risk to develop CMO (12.2% in DMEK alone and 6.1% in triple-DMEK). Pseudophakic bullous keratopathy (PBK ; 39.1% vs 9%; OR=3.5 (1.0 to 11.8), p=0.045) and epiretinal membrane (ERM; 39.1% vs 7.7%; OR=10.5 (3.4 to 32.3), p<0.001) were more frequently observed in patients who developed CMO. The occurrence of hyphaema during surgery was statistically associated with postoperative CMO (13% vs 1.3%; OR=7.1 (1.0 to 48.8) p=0.045). Peroperative epithelial debridement was statistically associated with postoperative CMO (65.2% vs 33.2%, p=0.005), but only in univariate analysis.
We identified a clinically significant CMO incidence of 9.35% after DMEK. Patients with a history of ERM, PBK and intraoperative hyphaema may be at risk of developing CMO after DMEK surgery and should be monitored.
确定单纯后弹力层内皮角膜移植术（DMEK）以及联合白内障手术（三联-DMEK）后囊样黄斑水肿（CMO）的发生率及危险因素。
我们回顾了2019年1月至2020年3月期间在法国巴黎罗斯柴尔德基金会医院接受单纯DMEK手术或三联-DMEK手术患者的记录。术前黄斑光学相干断层扫描（OCT）发现已有CMO的患者被排除。对术后视力受损的患者进行了光谱域OCT检查。收集并分析了有关合并症、术中特征以及术后治疗或并发症的数据。进行了单因素和多因素分析。
246只眼中有23只（9.36%）在DMEK术后发生了具有临床意义的（cs）-CMO。三联-DMEK与发生CMO的较高风险无关（单纯DMEK组为12.2%，三联-DMEK组为6.1%）。发生CMO的患者中更常观察到假晶状体大泡性角膜病变（PBK；39.1%对9%；比值比[OR]=3.5[1.0至11.8]，p=0.045）和视网膜前膜（ERM；39.1%对7.7%；OR=10.5[3.4至32.3]，p<0.001）。手术期间前房积血的发生与术后CMO在统计学上相关（13%对1.3%；OR=7.1[1.0至48.8]，p=0.045）。术中上皮清创与术后CMO在统计学上相关（65.2%对33.2%，p=0.005），但仅在单因素分析中如此。
我们确定DMEK术后具有临床意义的CMO发生率为9.35%。有ERM、PBK病史以及术中前房积血的患者在DMEK手术后可能有发生CMO的风险，应予以监测。
