Cornea and Refractive Surgery Unit, Instituto Microcirurgia Ocular (IMO), Carrer Josep Maria Lladó, 3, 08035, Barcelona, Spain.
NOVA Medical School, Faculdade de Ciências Médicas - Universidade Nova de Lisboa (NMS|FCM-UNL), Lisbon, Portugal.
Sci Rep. 2023 Feb 9;13(1):2375. doi: 10.1038/s41598-023-29127-5.
The aim of this study was to analyze the outcomes of eyes with visually significant cystoid macular œdema (vs-CMO) after Descemet membrane endothelial keratoplasty (DMEK) in a referral center for keratoplasty in Spain. We conducted a retrospective, single-surgeon case series of eyes that developed post-DMEK vs-CMO performed between January 2011 and December 2020. Data collected included: indication for DMEK; biometric data; ocular comorbidities; past medical history; time to detection of vs-CMO after DMEK (T, weeks); best-corrected visual acuity (BCVA, logMAR) and central retinal thickness (CRT, µm) at diagnosis of vs-CMO, after resolution of CMO, and at last follow-up; and management strategy. Main outcomes analyzed were incidence of vs-CMO, improvement in BCVA and CRT after treatment of vs-CMO. Of 291 consecutive DMEK surgeries, 14 eyes of 13 patients (4.8%) developed vs-CMO. Five patients (38.5%) had history of CMO, and 28.6% of eyes had ophthalmic comorbidities. Median (P25-P75) T was 4 (3-10) weeks. Treatment success was observed in 12/13 eyes (92.3%), two of which required second-line treatment. In successful cases (median time-to-resolution 3.0 (2.0-3.5) months), median BCVA improved from 0.60 (0.40-0.80) logMAR to 0.30 (0.15-0.40) logMAR (p = 0.002) after treatment, and median CRT improved from 582.5 (400.0-655.0) µm to 278.0 (258.0-294.0) µm (p = 0.005). In our study, we found a 4.8% rate of post-DMEK vs-CMO, with most cases occurring in the first 3 months after surgery. Good functional and anatomical outcomes are expected in most eyes, without treatment-related complications or implications in graft outcomes. Additional studies are encouraged to determine a standardized protocol for post-DMEK vs-CMO.
本研究旨在分析西班牙一家角膜移植转诊中心接受 Descemet 膜内皮角膜移植（DMEK）后出现明显囊样黄斑水肿（vs-CMO）的患者的治疗结果。我们对 2011 年 1 月至 2020 年 12 月间行 DMEK 术后发生 vs-CMO 的患者进行了回顾性、单手术医生病例系列研究。收集的数据包括：DMEK 的适应证；生物测量数据；眼部合并症；既往病史；DMEK 后 vs-CMO 检出时间（T，周）；vs-CMO 诊断时、CMO 消退后和最后随访时的最佳矫正视力（BCVA，logMAR）和中心视网膜厚度（CRT，µm）；以及治疗策略。主要分析指标为 vs-CMO 的发生率、vs-CMO 治疗后的 BCVA 和 CRT 改善情况。在 291 例连续 DMEK 手术中，13 例患者的 14 只眼（4.8%）发生了 vs-CMO。5 例（38.5%）患者有 CMO 病史，28.6%的眼有眼部合并症。中位（25%分位数-75%分位数）T 为 4（3-10）周。13 只眼中有 12 只（92.3%）治疗成功，其中 2 只需要二线治疗。在治疗成功的病例中（中位缓解时间 3.0（2.0-3.5）个月），BCVA 从 0.60（0.40-0.80）logMAR 改善至 0.30（0.15-0.40）logMAR（p=0.002），CRT 从 582.5（400.0-655.0）µm 改善至 278.0（258.0-294.0）µm（p=0.005）。在本研究中，我们发现 DMEK 术后 vs-CMO 的发生率为 4.8%，大多数病例发生在术后 3 个月内。大多数患者的功能和解剖学结果良好，无治疗相关并发症，也不会影响移植物的结果。鼓励开展更多的研究，以确定 DMEK 术后 vs-CMO 的标准化治疗方案。
