Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
Cornea. 2023 Dec 1;42(12):1497-1502. doi: 10.1097/ICO.0000000000003215. Epub 2022 Dec 19.
The aim of the study was to report clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) combined with transscleral-sutured intraocular lens (IOL) compared with DMEK combined with phacoemulsification and posterior chamber IOL (Phaco-DMEK).
A retrospective chart review of all patients who underwent DMEK combined with transscleral-sutured intraocular lens fixation or combined with phacoemulsification for Fuchs endothelial corneal dystrophy from 2016 to 2021 at the Toronto Western Hospital or the Kensington Eye Institute (Toronto, ON, Canada) and had at least 18 months of follow-up was performed. Main outcomes were postoperative distance-corrected visual acuity, rebubbling rate, graft survival rate, and complications.
Twenty-one cases of DMEK combined with transscleral-sutured IOL (DMEK-TSS-IOL) and 44 cases of Phaco-DMEK were evaluated. Twelve eyes (57.15%) had a foldable acrylic 3-piece IOL (AR40E) and 9 (42.85%) had a single-piece polymethylmethacrylate (PMMA) IOL (CZ70BD). LogMAR distance-corrected visual acuity improved significantly from 1.48 ± 0.62 (SD) to 0.86 ± 0.82 ( P = 0.01) 12 months after DMEK-TSS-IOL and from 0.41 ± 0.29 logMAR to 0.11 ± 0.11 logMAR ( P < 0.0001) after Phaco-DMEK. No statistically significant differences were observed in donor ( P = 0.97) or 1-year postoperative endothelial cell density ( P = 0.11) between the groups. Rebubbling was necessary in 33.33% of eyes in DMEK-TSS-IOL compared with 25% of Phaco-DMEK eyes ( P = 0.55). Graft survival rate was 76.19% in the DMEK-TSS-IOL group compared with 90.90% in the Phaco-DMEK group ( P = 0.13).
Transscleral-sutured IOL combined with DMEK is an option for the management of endothelial diseases in aphakic eyes or those which require IOL exchange for the experienced surgeon. However, when compared with routine Phaco-DMEK, there are higher complication and lower survival rates at 18 months.
本研究旨在报告与 Descemet 膜内皮角膜移植术（DMEK）联合后房型超声乳化白内障吸除术和人工晶状体植入术（Phaco-DMEK）相比，DMEK 联合经巩膜缝线固定型人工晶状体（TSS-IOL）治疗 Fuchs 内皮角膜营养不良的临床结果。
对 2016 年至 2021 年在多伦多西部医院或肯辛顿眼科研究所（多伦多，ON，加拿大）接受 DMEK 联合 TSS-IOL 或 Phaco-DMEK 治疗 Fuchs 内皮角膜营养不良的患者进行回顾性图表分析，这些患者至少随访 18 个月。主要观察指标为术后远视力矫正、再次注气、移植物存活率和并发症。
共评估了 21 例 DMEK 联合 TSS-IOL（DMEK-TSS-IOL）和 44 例 Phaco-DMEK 患者。12 只眼（57.15%）植入折叠式丙烯酸 3 部件人工晶状体（AR40E），9 只眼（42.85%）植入单件式聚甲基丙烯酸甲酯（PMMA）人工晶状体（CZ70BD）。DMEK-TSS-IOL 术后 12 个月，LogMAR 远视力矫正从 1.48±0.62（SD）显著提高至 0.86±0.82（P=0.01），Phaco-DMEK 术后 12 个月从 0.41±0.29 LogMAR 提高至 0.11±0.11 LogMAR（P<0.0001）。两组间供体（P=0.97）或术后 1 年内皮细胞密度（P=0.11）无统计学差异。DMEK-TSS-IOL 组中 33.33%的眼需要再次注气，而 Phaco-DMEK 组中需要再次注气的眼占 25%（P=0.55）。DMEK-TSS-IOL 组移植物存活率为 76.19%，Phaco-DMEK 组为 90.90%（P=0.13）。
对于无晶状体眼或需要更换人工晶状体的患者，经巩膜缝线固定型人工晶状体联合 DMEK 是治疗后发性白内障或内皮疾病的一种选择。然而，与常规 Phaco-DMEK 相比，在 18 个月时，该方法的并发症发生率更高，移植物存活率更低。
