Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.
Institute for Medical Statistics and Computational Biology (IMSB), University of Cologne, Germany; and.
Cornea. 2023 Aug 1;42(8):940-945. doi: 10.1097/ICO.0000000000003141. Epub 2022 Nov 21.
The aim of this study was to quantify preparation difficulties and complications during DMEK graft preparation and their influence on clinical outcome.
A retrospective evaluation of 214 consecutive DMEK surgeries from the prospective Cologne DMEK database was performed between July 2018 and December 2019. Preparation conditions (such as central and peripheral adherences, tissue fragility, and Descemet membrane splitting) were quantified and divided into 3 groups: easy, difficult, and very difficult preparation. At follow-up (3, 6, and 12 months after DMEK), best spectacle-corrected visual acuity, endothelial cell count (ECC), and rebubbling rates were evaluated and compared between groups.
An easy preparation was possible in 41.6% of cases (group 1, n = 89), a difficult preparation of the DMEK graft occurred in 30.8% (group 2, n = 66), and a very difficult preparation occurred in 27.6% (group 3, n = 59). There was no difference between groups for best spectacle-corrected visual acuity at 3, 6, and 12 months ( P = 0.179, P = 0.325, and P = 0.682, respectively) or for ECC at 3 and 6 months ( P = 0.537 and P = 0.606, respectively). Only at 12 months, the ECC was slightly significant between groups ( P = 0.045). Regarding the rebubbling rate, there was no difference ( P = 0.585). 17.9% of eyes from group 1, 25.7% of eyes from group 2, and 23.7% of eyes from group 3 received at least 1 rebubbling.
These data suggest that difficult preparation conditions do not lead to any worsening of visual acuity or rebubbling rate in the 1-year outcome after DMEK. The endothelial cell density at 12 months showed slightly poorer results in the cases of very difficult preparation.
本研究旨在量化 DMEK 移植物准备过程中的准备难度和并发症，并评估其对临床结果的影响。
回顾性分析 2018 年 7 月至 2019 年 12 月间连续 214 例接受 DMEK 手术患者的前瞻性科隆 DMEK 数据库。评估和量化准备条件（如中央和周边粘连、组织易碎性和 Descemet 膜分离），并将其分为 3 组：容易、困难和非常困难的准备。在 DMEK 后 3、6 和 12 个月进行随访，评估和比较各组间最佳矫正视力、内皮细胞计数（ECC）和再注气率。
41.6%（89 例）的病例可以进行容易的准备，30.8%（66 例）的病例为困难准备，27.6%（59 例）的病例为非常困难准备。在 3、6 和 12 个月时，最佳矫正视力（ P = 0.179、P = 0.325 和 P = 0.682）或 ECC 在 3 和 6 个月时（ P = 0.537 和 P = 0.606），各组之间均无差异。仅在 12 个月时，ECC 之间存在显著差异（ P = 0.045）。关于再注气率，各组之间无差异（ P = 0.585）。第 1 组中有 17.9%的眼、第 2 组中有 25.7%的眼和第 3 组中有 23.7%的眼至少接受了 1 次再注气。
这些数据表明，在 DMEK 后 1 年的结果中，困难的准备条件不会导致视力或再注气率的恶化。在非常困难的准备情况下，12 个月时内皮细胞密度的结果略差。
