From Corneal and External Diseases Unit, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (H.W.R, V.K, M.P, N.D, M.R.W).
From Corneal and External Diseases Unit, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (H.W.R, V.K, M.P, N.D, M.R.W); UCL Institute of Ophthalmology, London, United Kingdom (V.K, M.R.W).
Am J Ophthalmol. 2022 Aug;240:23-29. doi: 10.1016/j.ajo.2022.02.009. Epub 2022 Feb 25.
To evaluate the clinical results of Descemet membrane endothelial keratoplasty (DMEK) without any intraoperative or postoperative posturing.
Retrospective, noncomparative, and interventional case series.
One hundred thirty-four (134) consecutive eyes of 101 patients requiring DMEK for any cause of endothelial failure were included. Descemet membrane endothelial keratoplasty was performed with an intraoperative inferior PI. After unscrolling and centration of the graft, the anterior chamber was near completely filled with 20% SF6. After filling the eye with gas there was no intraoperative tamponade time, and patients did not posture postoperatively. Main outcome measures were: graft detachment rate, rebubbling rate, primary and secondary failure rates, rejection rate, intraoperative and postoperative complications, and visual acuity 3 and 12 months after surgery.
Five of 134 (3.7%) developed graft detachment greater than one-third of the graft area, and 19 of 134 (14.2%) developed graft detachment less than one-third of the graft area. A rebubble procedure was performed in 19 of 134 (14.2%); of those, the average number of rebubbling procedures performed was 1.13 (range, 1-2). Primary failure occurred in 6 of 134 (4.5%).Twelve-month graft survival occurred in 122 of 134 eyes (91.0%), with secondary failure within the first 12 months accounting for failure of 6 of 134 (4.5%). Nine of 134 (6.7%) cases had a recorded episode of endothelial rejection. The average time for rejection episode was 9.5 months (range, 1-20 months) after surgery.
A total of 134 'posture-less' DMEKs did not suffer very high rates of graft detachment, rebubbling, or other postoperative complications, even with immediate erect posturing after surgery.
评估不进行任何术中或术后体位的 Descemet 膜内皮角膜移植术（DMEK）的临床效果。
回顾性、非对照、干预性病例系列。
纳入了 101 例因内皮功能衰竭而需要 DMEK 的 134 只（134 例）连续眼。术中采用下方 PI 进行 Descemet 膜内皮角膜移植术。在展开和移植片定位后，前房充满 20%SF6 至近乎完全充盈。填充眼球后，无术中填塞时间，患者术后无需体位。主要观察指标是：移植片脱离率、再灌流率、原发性和继发性失败率、排斥率、术中及术后并发症以及术后 3 个月和 12 个月的视力。
134 只眼中有 5 只（3.7%）发生大于移植片面积三分之一的移植片脱离，134 只眼中有 19 只（14.2%）发生小于移植片面积三分之一的移植片脱离。134 只眼中有 19 只（14.2%）需要进行再灌流手术；其中，平均再灌流手术次数为 1.13 次（范围，1-2 次）。原发性失败发生在 134 只眼中的 6 只（4.5%）。134 只眼中有 122 只（91.0%）在 12 个月时移植片存活，继发性失败在 12 个月内占 134 只眼中的 6 只（4.5%）。134 只眼中有 9 只（6.7%）出现记录到的内皮排斥事件。术后 9.5 个月（范围，1-20 个月）出现排斥事件的平均时间。
总共 134 例“无体位”DMEK 手术并未出现很高的移植片脱离、再灌流或其他术后并发症发生率，即使术后立即采取直立体位。
