Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal.
Cornea. 2023 Aug 1;42(8):980-985. doi: 10.1097/ICO.0000000000003131. Epub 2022 Sep 16.
The purpose of this study was to report long-term results of Descemet stripping without endothelial keratoplasty (DWEK) associated with phacoemulsification in patients with early-stage central Fuchs endothelial corneal dystrophy.
This is a retrospective study, including all patients submitted to DWEK associated with cataract surgery with a minimum follow-up of 24 months. Included patients had central confluent guttae confirmed with specular microscopy, a clear peripheral endothelium (with a peripheral endothelial count >1500 cells/mm 2 ), and a central pachymetry <600 μm. The main end points were the presence of a clear cornea and time that was needed to achieve transparency, best-corrected visual acuity in logMAR, endothelial central cell count (ECC), and central pachymetry.
A total of 22 eyes were included with a mean follow-up of 40.8 ± 10.5 months. At baseline, mean central pachymetry was 536 ± 34 mm and 6 eyes had countable ECC (mean 1138 ± 190 cells/mm 2 ). Twenty eyes (90.9%) achieved good corneal transparency 3.2 ± 1.1 months after surgery. There was a significant improvement in logMAR best-corrected visual acuity compared with baseline (0.13 ± 0.10 vs. 0.48 ± 0.24, respectively, P < 0.001). Endothelial central repopulation was observed in all successful cases. Twelve months after DWEK, ECC was 1449 ± 344 cells/mm 2 and 1393 ± 450 cells/mm 2 at the end of follow-up, without a significant decrease between this period ( P = 0.081). Only 2 eyes (9.1%) did not achieve corneal transparency and were submitted to an endothelial keratoplasty.
According to our results, DWEK is a safe and effective procedure in selected cases of early-stage central Fuchs endothelial corneal dystrophy. This seems to be a promising technique, delaying or avoiding endothelial transplantation.
本研究旨在报告早期中央型 Fuchs 内皮角膜营养不良患者行超声乳化白内障吸除术联合去内皮角膜层间切除术（DWEK）的长期结果。
这是一项回顾性研究，纳入所有行 DWEK 联合白内障手术的患者，随访时间至少 24 个月。纳入患者的中央区融合性胶滴经角膜内皮镜检查证实，周边角膜内皮细胞密度＞1500 个/平方毫米，中央角膜厚度＜600 微米。主要观察终点为角膜透明情况、达到透明所需的时间、最佳矫正视力对数视力表（logMAR）、角膜内皮细胞计数（ECC）和中央角膜厚度。
共纳入 22 只眼，平均随访时间为 40.8±10.5 个月。基线时，平均中央角膜厚度为 536±34 微米，6 只眼可计数的 ECC（平均 1138±190 个/平方毫米）。术后 3.2±1.1 个月，20 只眼（90.9%）获得良好的角膜透明性。与基线相比，logMAR 最佳矫正视力有显著改善（分别为 0.13±0.10 和 0.48±0.24，P＜0.001）。所有成功病例均观察到内皮中央区再增殖。DWEK 术后 12 个月，ECC 为 1449±344 个/平方毫米，随访结束时为 1393±450 个/平方毫米，此期间无明显下降（P=0.081）。仅 2 只眼（9.1%）未获得角膜透明性，行内皮角膜移植术。
根据我们的结果，对于早期中央型 Fuchs 内皮角膜营养不良患者，DWEK 是一种安全有效的手术方法。这似乎是一种很有前途的技术，可以延迟或避免内皮移植。
