Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.
Graefes Arch Clin Exp Ophthalmol. 2022 May;260(5):1573-1582. doi: 10.1007/s00417-021-05506-4. Epub 2021 Dec 4.
This study aims to assess the results, rebubbling rate, and graft survival after Descemet membrane endothelial keratoplasty (DMEK) with regard to the number and type of previous glaucoma surgeries.
This is a clinical retrospective review of 1845 consecutive DMEK surgeries between 07/2011 and 08/2017 at the Department of Ophthalmology, University of Cologne. Sixty-six eyes were included: group 1 (eyes with previous glaucoma drainage devices (GDD); n = 27) and group 2 (eyes with previous trabeculectomy (TE); n = 39). Endothelial cell loss (ECL), central corneal thickness, graft failure, rebubbling rate, and best spectacle-corrected visual acuity (BSCVA) up to 3 years after DMEK were compared between subgroups of patients with different numbers of and the two most common types of glaucoma surgeries either GDD or TE or both.
Re-DMEK rate due to secondary graft failure was 55.6% (15/27) in group 1 and 35.9% in group 2. The mean graft survival time in group 1 was 25 ± 11 months and 31.3 ± 8.6 months in group 2 (p = 0.009). ECL in surviving grafts in group 1 was 35% (n = 13) at 6 months, 36% at 12 months (n = 8), and 27% (n = 4) at 2 years postoperatively. In group 2, ECL in surviving grafts was 41% (n = 10) at 6 months, 36% (n = 9) at 12 months, and 38% (n = 8) at 2 years postoperatively. Rebubbling rate in group 1 was 18.5% (5/27) and 35.9% (14/39) in group 2 (p = 0.079).
Eyes with previous GDD had no higher risk for an increased rebubbling rate but a higher risk for a re-DMEK due to secondary graft failure with a mean transplant survival time of about 2 years. Compared to eyes with preexisting glaucoma drainage device, eyes after trabeculectomy had less secondary graft failures and a longer mean graft survival rate.
本研究旨在评估 2011 年 7 月至 2017 年 8 月期间在科隆大学眼科进行的 1845 例连续的 Descemet 膜内皮角膜移植术（DMEK）的结果、再穿刺率和移植物存活率，并考虑到之前青光眼手术的数量和类型。
这是一项回顾性临床研究，纳入了 1845 例连续的 DMEK 手术，时间为 2011 年 7 月至 2017 年 8 月，在科隆大学眼科进行。共纳入 66 只眼：第 1 组（有先前青光眼引流装置（GDD）的眼；n=27）和第 2 组（有先前小梁切除术（TE）的眼；n=39）。在 DMEK 术后 3 年内，比较不同数量的患者亚组和两种最常见的青光眼手术（GDD 或 TE 或两者兼有）的患者之间的内皮细胞丢失（ECL）、中央角膜厚度、移植物失败、再穿刺率和最佳矫正视力（BSCVA）。
第 1 组中因继发性移植物失败而再次行 DMEK 的比例为 55.6%（15/27），第 2 组为 35.9%。第 1 组的平均移植物存活时间为 25±11 个月，第 2 组为 31.3±8.6 个月（p=0.009）。第 1 组中存活移植物的 ECL 在术后 6 个月时为 35%（n=13），12 个月时为 36%（n=8），2 年时为 27%（n=4）。第 2 组中存活移植物的 ECL 在术后 6 个月时为 41%（n=10），12 个月时为 36%（n=9），2 年时为 38%（n=8）。第 1 组的再穿刺率为 18.5%（5/27），第 2 组为 35.9%（14/39）（p=0.079）。
与之前存在 GDD 的眼睛相比，有青光眼引流装置的眼睛的再穿刺率没有更高的风险，但因继发性移植物失败导致再次行 DMEK 的风险更高，平均移植物存活时间约为 2 年。与存在先前青光眼引流装置的眼睛相比，接受小梁切除术的眼睛的继发性移植物失败较少，平均移植物存活率较长。
