University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France.
Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, Clermont-Ferrand, France.
Cornea. 2022 Jul 1;41(7):815-825. doi: 10.1097/ICO.0000000000002855. Epub 2021 Dec 7.
Descemetorhexis without endothelial keratoplasty (DWEK) is an innovative corneal intervention and potentially effective against Fuchs endothelial corneal dystrophy (FECD). We aimed to conduct a systematic review and meta-analysis on the outcomes of DWEK, associated or not with phacoemulsification (PKE) and rho-kinase inhibitor (RHOKI) in FECD.
PubMed, Cochrane Library, Embase, ClinicalTrials.gov , and Science Direct were searched for studies until November 29, 2020. We performed random-effects meta-analyses and meta-regressions, stratified by the type of intervention and descemetorhexis size (PROSPERO CRD42020167566).
We included 11 articles (mainly case series, both prospective and retrospective), representing 127 eyes of 118 patients. DWEK globally improved visual acuity (effect size = -1.11, 95% confidence interval, -1.70 to -0.52, P < 0.001) and pachymetry (-1.25, -1.92 to -0.57, P < 0.001), without significant effects on endothelial cell count (-0.59, -2.00 to 0.83, P = 0.419). The 3 types of interventions (ie, DWEK ± RHOKI, DWEK ± PKE, and DWEK ± PKE ± RHOKI) improved visual acuity and pachymetry in FECD. A descemetorhexis size ≤4 mm improved visual acuity (-0.72, -1.29 to -0.14, P < 0.001) and pachymetry (-0.68, -0.98 to -0.38, P < 0.001), whereas >4 mm did not. Overall, DWEK failure (ie, the prevalence of EK after DWEK) was 17% (7%-27%, P < 0.001), with 4% (0%-8%, P = 0.08) for a descemetorhexis size ≤4 mm.
Despite the lack of comparative studies, DWEK seemed to improve visual acuity and pachymetry in early stages of FECD. A descemetorhexis size ≤4 mm was associated with the best visual outcomes and pachymetry.
去内皮角膜切除术（DWEK）不联合内皮移植术是一种创新的角膜介入治疗方法，可能对 Fuchs 内皮角膜营养不良（FECD）有效。我们旨在对 DWEK 的结果进行系统评价和荟萃分析，包括 DWEK 联合或不联合超声乳化术（PKE）和 Rho 激酶抑制剂（RHOKI）治疗 FECD 的情况。
检索 PubMed、Cochrane 图书馆、Embase、ClinicalTrials.gov 和 Science Direct，检索时间截至 2020 年 11 月 29 日。我们进行了随机效应荟萃分析和荟萃回归分析，按干预类型和撕囊大小进行分层（PROSPERO CRD42020167566）。
我们纳入了 11 篇文章（主要为前瞻性和回顾性病例系列研究），共涉及 118 例患者的 127 只眼。DWEK 总体上改善了视力（效应大小=-1.11，95%置信区间：-1.70 至-0.52，P<0.001）和角膜厚度（-1.25，-1.92 至-0.57，P<0.001），但对内皮细胞计数无显著影响（-0.59，-2.00 至 0.83，P=0.419）。3 种干预方式（即 DWEK±RHOKI、DWEK±PKE 和 DWEK±PKE±RHOKI）均改善了 FECD 患者的视力和角膜厚度。撕囊大小≤4mm 可改善视力（-0.72，-1.29 至-0.14，P<0.001）和角膜厚度（-0.68，-0.98 至-0.38，P<0.001），而>4mm 则不然。总体而言，DWEK 失败（即 DWEK 后 EK 的发生率）为 17%（7%-27%，P<0.001），撕囊大小≤4mm 时为 4%（0%-8%，P=0.08）。
尽管缺乏对照研究，但 DWEK 似乎可以改善 FECD 早期的视力和角膜厚度。撕囊大小≤4mm 与最佳视力和角膜厚度相关。
