Cornea Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA; and.
Cornea. 2023 Aug 1;42(8):1037-1040. doi: 10.1097/ICO.0000000000003221. Epub 2022 Dec 19.
There are limited data about long-term durability of endothelial rejuvenation after Descemet stripping only (DSO). This study reports a case of bilaterally recurrent endothelial dysfunction and guttae formation after initially successful DSO in combination with cataract extraction (DSO-CE).
This is a retrospective case report. A 49-year-old man with Fuchs endothelial corneal dystrophy with bilateral visually significant endothelial guttae (predominantly confluent centrally) and concomitant cataract underwent DSO-CE bilaterally. Postoperative course to long-term outcome at 6 years was analyzed.
Baseline central corneal thickness (CCT) was 568 μm in OD and 582 μm in OS. Preoperatively, both eyes had no countable central endothelial cells but good peripheral endothelial mosaic. In both eyes, the cornea clinically cleared at approximately 1 month postoperatively after DSO-CE. In short-term follow-up (OD postoperative month 6 and OS postoperative month 3), CCT was 556 μm in OD and 561 μm in OS and central endothelial cell density was 1352 cells/mm 2 in OD and 880 cells/mm 2 in OS. The patient returned to our center in postoperative year 6 OU. At this time, OU had interval formation of guttae within the descemetorhexis, with increased CCT (OD 631 μm and OS 609 μm) and decreased central endothelial cell density (OD 728 cells/mm 2 and OS 609 cells/mm 2 ).
After DSO, progressive endothelial dysfunction with new guttae formation can occur within the descemetorhexis region of repopulated endothelium. Larger analyses with longer follow-up are needed to better characterize long-term outcomes of DSO.
关于 Descemet 膜撕除术（DSO）后内皮细胞年轻化的长期耐久性，目前数据有限。本研究报告了一例最初成功行 DSO 联合白内障超声乳化吸除术（DSO-CE）后，双侧内皮功能障碍和后弹力层皱褶复发的病例。
这是一项回顾性病例报告。一名 49 岁男性，患有 Fuchs 内皮角膜营养不良，双眼有明显的内皮细胞后弹力层皱褶（主要为中央融合性），同时伴有白内障，行双眼 DSO-CE。分析术后至 6 年的长期结果。
OD 的中央角膜厚度（CCT）基线为 568μm，OS 的 CCT 为 582μm。术前，双眼均无法计数中央内皮细胞，但周边内皮细胞马赛克结构良好。双眼在 DSO-CE 术后约 1 个月，角膜临床恢复透明。短期随访（OD 术后 6 个月和 OS 术后 3 个月）时，OD 的 CCT 为 556μm，OS 的 CCT 为 561μm，OD 的中央内皮细胞密度为 1352 个/mm2，OS 的中央内皮细胞密度为 880 个/mm2。患者在术后 6 年时返回我院。此时，双眼在撕囊区后弹力层内出现皱褶间隔，CCT 增加（OD 631μm，OS 609μm），中央内皮细胞密度降低（OD 728 个/mm2，OS 609 个/mm2）。
在 DSO 后，在重新填充内皮的撕囊区，内皮功能障碍可能会逐渐进展，并伴有新的皱褶形成。需要更大规模的分析和更长时间的随访，以更好地描述 DSO 的长期结果。
