Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.
Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands.
Cornea. 2023 Oct 1;42(10):1229-1239. doi: 10.1097/ICO.0000000000003130. Epub 2022 Sep 28.
The aim of this study was to evaluate clinical outcomes and graft survival in a large patient cohort up to 10 years after Descemet membrane endothelial keratoplasty (DMEK) based on surgical indication and Fuchs endothelial corneal dystrophy (FECD) severity.
The cohort in this retrospective study included 750 eyes that underwent DMEK for FECD (86%), bullous keratopathy (BK, 9%), and other indications (5%). Based on the modified Krachmer grading, 186 eyes (29%) had moderate FECD (Krachmer grade 3-4) and 440 eyes (68%) had advanced FECD (Krachmer grade 5-6). Main outcome measures were best-corrected visual acuity (BCVA), central corneal thickness, endothelial cell density (ECD), endothelial cell loss (ECL), postoperative complication rate, and graft survival.
The mean 10-year BCVA was 0.08 ± 0.28 logMAR (n = 96), and the BCVA remained stable between 5 and 10 years postoperatively (all P > 0.05). The mean ECL at 5 and 10 years was 56% ± 17% (n = 460) and 66% ± 14% (n = 96), respectively ( P < 0.05). The 10-year graft survival rate for the total cohort was 0.85 (95% confidence interval, 0.82-0.89). BCVA and ECD differed at 1 to 5 years between eyes with different surgical indications (all P < 0.05), and FECD eyes had higher graft survival compared with BK eyes (0.90 vs. 0.60, P = 0.001). Moderate FECD eyes had better BCVA, ECD, and graft survival outcomes than advanced FECD eyes (all P < 0.05). Minor graft detachment ( P = 0.04) and lower donor ECD ( P = 0.01) were related to lower 10-year ECD.
Long-term outcomes and graft survival after DMEK were better in FECD eyes than BK eyes and were also related to FECD disease severity. Eyes operated for moderate FECD showed the highest graft survival probability and excellent long-term outcomes.
本研究旨在评估基于手术适应证和 Fuchs 内皮角膜营养不良（FECD）严重程度，在 10 年时间内接受 Descemet 膜内皮角膜移植术（DMEK）治疗的大量患者的临床结局和移植物存活率。
本回顾性队列研究共纳入 750 只接受 DMEK 治疗的 FECD（86%）、大泡性角膜病变（BK，9%）和其他适应证（5%）的眼睛。根据改良的 Krachmer 分级，186 只眼（29%）为中度 FECD（Krachmer 分级 3-4），440 只眼（68%）为重度 FECD（Krachmer 分级 5-6）。主要观察指标为最佳矫正视力（BCVA）、中央角膜厚度、内皮细胞密度（ECD）、内皮细胞丢失（ECL）、术后并发症发生率和移植物存活率。
平均 10 年 BCVA 为 0.08 ± 0.28 logMAR（n = 96），术后 5 年至 10 年 BCVA 保持稳定（均 P > 0.05）。平均 ECL 在 5 年和 10 年分别为 56% ± 17%（n = 460）和 66% ± 14%（n = 96）（P < 0.05）。全队列 10 年移植物存活率为 0.85（95%置信区间，0.82-0.89）。不同手术适应证眼的 BCVA 和 ECD 在 1 年至 5 年之间存在差异（均 P < 0.05），且与 BK 眼相比，FECD 眼的移植物存活率更高（0.90 比 0.60，P = 0.001）。中度 FECD 眼的 BCVA、ECD 和移植物存活率结果均优于重度 FECD 眼（均 P < 0.05）。轻微的移植物脱离（P = 0.04）和更低的供体 ECD（P = 0.01）与 10 年时较低的 ECD 相关。
与 BK 眼相比，DMEK 治疗后的 FECD 眼的长期结局和移植物存活率更好，并且也与 FECD 疾病严重程度有关。中重度 FECD 眼的移植物存活率最高，长期效果也最好。
