Ophthalmology Department, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France.
Research Support Unit, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France.
PLoS One. 2022 May 12;17(5):e0267940. doi: 10.1371/journal.pone.0267940. eCollection 2022.
Previous comparative studies show that triple Descemet membrane endothelial keratoplasty (DMEK) (i.e. phacoemulsification followed immediately by DMEK) has either equivalent or better visual outcomes than DMEK in pseudophakic patients. To resolve this discrepancy, a retrospective cohort study was conducted. All consecutive patients with Fuchs Endothelial Corneal Dystrophy who underwent triple or pseudophakic DMEK in 2015-2019 in a tertiary-care hospital (France) and were followed for >12 months were compared in terms of best spectacle-corrected visual acuity (BSCVA), final refractive outcomes, and endothelial-cell loss at 12 months as well as rebubbling rates. The triple-DMEK (40 eyes, 34 patients) and pseudophakic-DMEK (55 eyes, 43 patients) groups were similar in terms of age and other baseline variables. They also did not differ in final BSCVA (both 0.03 logMAR), final endothelial-cell loss (54% vs. 48%), or astigmatism (-1.25 vs. -1 D). At 12 months, triple-DMEK associated with significantly smaller residual hyperopia (0.75 vs. 1 D; p = 0.04) and spherical equivalence (0 vs. 0.5 D; p = 0.02). Triple-DMEK also tended to associate with more frequent rebubbling (40% vs. 24%, p = 0.09). In conclusion, while triple-DMEK and pseudophakic-DMEK achieved similar visual acuity improvement, triple-DMEK was superior in terms of final sphere and spherical refraction but also tended to have higher complication rates.
先前的对比研究表明，在白内障患者中，三联合 Descemet 膜内皮角膜移植术（DMEK）（即超声乳化术后立即进行 DMEK）的视力结果与 DMEK 相当或更好。为了解决这一差异，进行了一项回顾性队列研究。在法国的一家三级护理医院，对 2015 年至 2019 年间接受三联合或假性 DMEK 的所有连续患有 Fuchs 内皮角膜营养不良的患者进行了比较，比较指标包括最佳矫正视力（BCVA）、最终屈光结果、术后 12 个月内皮细胞丢失率以及复发性气泡。三联合 DMEK（40 只眼，34 例患者）和假性 DMEK（55 只眼，43 例患者）组在年龄和其他基线变量方面相似。两组在最终 BCVA（均为 0.03 logMAR）、最终内皮细胞丢失（54% vs. 48%）或散光（-1.25 vs. -1 D）方面也没有差异。术后 12 个月，三联合 DMEK 与显著更小的残余远视（0.75 vs. 1 D；p = 0.04）和球镜等效性（0 vs. 0.5 D；p = 0.02）相关。三联合 DMEK 也倾向于与更高的复发性气泡（40% vs. 24%，p = 0.09）相关。结论：尽管三联合 DMEK 和假性 DMEK 都能提高视力，但三联合 DMEK 在最终球镜和球镜屈光度方面更具优势，但也有更高的并发症发生率。
