Morelli Alberto, Ferrandina Rosangela, Favuzza Eleonora, Cennamo Michela, Mencucci Rita
Eye Clinic, Careggi Hospital, Department of Neurosciences, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, 50134 Florence, Italy.
Department of Biotechnology and Medical-Surgical Sciences, 'Sapienza' University of Rome, 04100 Latina, Italy.
J Clin Med. 2022 Jul 25;11(15):4312. doi: 10.3390/jcm11154312.
Background: To compare the efficacy and safety of Descemet membrane endothelial keratoplasty (DMEK) surgery using the three-dimensional (3D) display system NGENUITY to DMEK surgery performed with the traditional microscope (TM) in patients affected by Fuchs Endothelial Corneal Disease (FECD). Methods: Retrospective comparative study of 40 pseudophakic eyes of 40 patients affected by FECD who underwent DMEK surgery. Twenty patients (3D group) were operated on using the 3D display system and 20 patients (TM group) were operated on using the traditional microscope. Best spectacle corrected visual acuity (BSCVA), central corneal thickness (CCT), endothelial cell density (ECD) and corneal densitometry (CD) values were documented before and at 1, 3 and 6 months after DMEK. Intra- and postoperative complications were recorded. Results: The baseline assessments did not differ between the two groups (p > 0.05). Global surgical time and time to perform descemetorhexis were significantly lower in the TM group (p = 0.04 and p = 0.02, respectively). BSCVA, CCT, ECD and CD values did not differ significantly in the two groups at all follow-ups (p > 0.05). Complication rate was similar between the two groups. Conclusion: Three-dimensional display systems can be securely employed in DMEK surgery considering the satisfactory clinical outcomes, including Scheimpflug CD. Nevertheless, the slightly longer surgical time of the 3D DMEKs may lead to surgeons’ hesitancy. The main advantages of the heads-up approach may be the improved ergonomic comfort during surgery and the utility of assistants in surgical training.
比较在患有富克斯内皮角膜营养不良（FECD）的患者中，使用三维（3D）显示系统NGENUITY进行的Descemet膜内皮角膜移植术（DMEK）与使用传统显微镜（TM）进行的DMEK手术的疗效和安全性。方法：对40例接受DMEK手术的FECD患者的40只假晶状体眼进行回顾性比较研究。20例患者（3D组）使用3D显示系统进行手术，20例患者（TM组）使用传统显微镜进行手术。记录DMEK术前及术后1、3和6个月时的最佳矫正视力（BSCVA）、中央角膜厚度（CCT）、内皮细胞密度（ECD）和角膜密度测量（CD）值。记录术中及术后并发症。结果：两组的基线评估无差异（p>0.05）。TM组的总手术时间和撕除Descemet膜的时间显著更短（分别为p=0.04和p=0.02）。在所有随访中，两组的BSCVA、CCT、ECD和CD值均无显著差异（p>0.05）。两组的并发症发生率相似。结论：考虑到包括Scheimpflug角膜密度测量在内的令人满意的临床结果，三维显示系统可安全地用于DMEK手术。然而，3D DMEK手术时间略长可能会导致外科医生犹豫不决。平视方法的主要优点可能是手术过程中改善了人体工程学舒适度以及助手在手术培训中的实用性。
