Dockery Philip W, Parker Jack S, Birbal Rénuka S, Tong C Maya, Parker John S, Joubert Katelyn P, Melles Gerrit R J
Parker Cornea, Birmingham, AL, USA.
14523Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Eur J Ophthalmol. 2023 Jan;33(1):52-57. doi: 10.1177/11206721221123902. Epub 2022 Sep 15.
To evaluate the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) performed in eyes with comorbid keratoconus (KCN) and corneal endothelial dysfunction.
Twenty-five consecutive eyes of 14 patients with comorbid stable KCN underwent DMEK for corneal endothelial dysfunction; best spectacle corrected visual acuity (BSCVA), maximum corneal curvature (Kmax), maximum corneal power (Pmax), central corneal thickness (CCT), and intra- and postoperative complications were assessed.
Excluding eyes requiring re-transplantation for primary graft failure (n = 3), all eyes showed improvement in BSCVA, reaching ≥ 20/40 (0.5) in 86%, ≥ 20/25 (0.8) in 55%, and ≥ 20/20 (1.0) in 27% by one month postoperatively; 90%, 76%, and 48% by 6 months postoperatively; and 88%, 76%, and 47% by 12 months postoperatively. CCT decreased from 571μm preoperatively to 485μm at 1 month (p < 0.001) and 481μm at 12 months (p < 0.001). Kmax decreased by a median of 1.4 diopters (D) at 1 month (p = 0.003) and 3.1 D at 12 months (p = 0.021), and every eye with a preoperative Kmax ≥ 46 D demonstrated flattening. Pmax decreased by 2.1 D at 1 month (p = 0.001) and 4.0 D at 12 months (p = 0.016).
DMEK is technically feasible in eyes with comorbid KCN and may give excellent outcomes visual and refractive outcomes, including significant corneal flattening, which may potentially create a visually significant hyperopic shift in patients with severely ectatic corneas.
评估在合并圆锥角膜（KCN）和角膜内皮功能障碍的眼中进行Descemet膜内皮角膜移植术（DMEK）的临床效果。
14例合并稳定KCN的患者的25只连续眼因角膜内皮功能障碍接受了DMEK；评估了最佳矫正视力（BSCVA）、最大角膜曲率（Kmax）、最大角膜屈光力（Pmax）、中央角膜厚度（CCT）以及术中和术后并发症。
排除因原发性移植物失败需要再次移植的眼（n = 3），所有眼的BSCVA均有改善，术后1个月时86%的眼达到≥20/40（0.5），55%的眼达到≥20/25（0.8），27%的眼达到≥20/20（1.0）；术后6个月时分别为90%、76%和48%；术后12个月时分别为88%、76%和47%。CCT从术前的571μm降至术后1个月时的485μm（p < 0.001）和术后12个月时的481μm（p < 0.001）。Kmax在术后1个月时平均下降1.4屈光度（D）（p = 0.003），术后12个月时下降3.1 D（p = 0.021），术前Kmax≥46 D的每只眼均出现角膜变平。Pmax在术后1个月时下降2.1 D（p = 0.001），术后12个月时下降4.0 D（p = 0.016）。
DMEK在合并KCN的眼中技术上是可行的，并且可能带来出色的视觉和屈光效果，包括显著的角膜变平，这可能会在严重扩张性角膜的患者中产生具有视觉意义的远视偏移。
