Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands.
Hogeschool Utrecht, the Netherlands.
Cornea. 2023 Aug 1;42(8):970-979. doi: 10.1097/ICO.0000000000003115. Epub 2022 Aug 24.
The aim of this study was to evaluate how Scheimpflug-derived parameters of eyes with Fuchs endothelial corneal dystrophy (FECD) are influenced by Descemet membrane endothelial keratoplasty (DMEK) depending on FECD severity and the presence of subclinical edema.
A retrospective cohort study including 115 eyes (115 patients) that underwent DMEK for FECD and a control group of 27 eyes with nonpathological corneas was conducted. Preoperative and 6 months postoperative Scheimpflug imaging was used to analyze pachymetry, presence of tomographic features (loss of isopachs/displacement of the thinnest point/focal posterior depression), and corneal backscatter. FECD severity was based on the modified Krachmer scale and the absence/presence of subclinical edema.
Scheimpflug-derived pachymetry, tomographic, and corneal backscatter parameters were correlated with FECD severity, and all changed from preoperatively to postoperatively (all P < 0.05). Postoperative central corneal thickness, anterior and posterior corneal backscatter, and presence of focal posterior depression remained different from the control group (all P < 0.05). Of eyes without preoperative clinical edema (n = 75), 18.7% showed 0 or 1 tomographic feature (no edema group) and 82.4% had 2 or 3 features (subclinical edema group). Compared with the control group, postoperative best-corrected visual acuity for the "no edema" group did not differ (0.03 ± 0.12 vs. -0.02 ± 0.08 logarithm of the minimum angle of resolution, P = 0.150) but was worse for the subclinical edema group (0.06 ± 0.08 vs. -0.02 ± 0.08 logarithm of the minimum angle of resolution, P = 0.001).
For eyes without preoperative edema, more parameters reversed back to 'normal' levels than for eyes with (sub)clinical edema. Although most analyzed parameters correlated with FECD severity, corneal tomography might be best suited for objective grading of disease severity to aid in surgical decision-making.
本研究旨在评估 Fuchs 内皮角膜营养不良（FECD）患者接受 Descemet 膜内皮角膜移植术（DMEK）后，Scheimpflug 衍生参数如何受疾病严重程度和亚临床水肿的影响。
本回顾性队列研究纳入了 115 只眼（115 例患者），这些眼均因 FECD 接受了 DMEK 治疗，并纳入了 27 只非病变角膜的对照眼。术前和术后 6 个月的 Scheimpflug 成像用于分析角膜厚度、存在断层特征（等厚线缺失/最薄点移位/局灶性后凹）和角膜背散射。FECD 严重程度基于改良的 Krachmer 分级以及亚临床水肿的有无。
Scheimpflug 衍生的角膜厚度、断层和角膜背散射参数与 FECD 严重程度相关，且所有参数均从术前至术后发生改变（均 P < 0.05）。术后中央角膜厚度、前角膜背散射和后角膜背散射以及局灶性后凹的存在仍与对照组不同（均 P < 0.05）。在术前无临床水肿的眼（n = 75）中，18.7%存在 0 或 1 个断层特征（无水肿组），82.4%存在 2 或 3 个特征（亚临床水肿组）。与对照组相比，“无水肿”组术后最佳矫正视力差异无统计学意义（0.03 ± 0.12 对数最小分辨角视力 vs. -0.02 ± 0.08 对数最小分辨角视力，P = 0.150），但亚临床水肿组更差（0.06 ± 0.08 对数最小分辨角视力 vs. -0.02 ± 0.08 对数最小分辨角视力，P = 0.001）。
对于术前无水肿的眼，与有（亚）临床水肿的眼相比，更多的参数恢复到“正常”水平。虽然大多数分析参数与 FECD 严重程度相关，但角膜断层成像可能最适合用于疾病严重程度的客观分级，以辅助手术决策。
