Stuhlmacher Emilia Sophie, Suffo Shady, Munteanu Cristian, Seitz Berthold, Daas Loay
Department of Ophthalmology, Saarland University Medical Center UKS, Kirrberger Straße 100, Building 22, 66421 Homburg/Saar, Germany.
J Clin Med. 2023 Jan 19;12(3):811. doi: 10.3390/jcm12030811.
Evaluating the learning curve of individual surgeons for Descemet Membrane Endothelial Keratoplasty (DMEK) and Triple-DMEK and assessing outcome with experience.
The first 41 and the last 41 surgeries of each of the four surgeons were retrospectively included. Surgery duration and graft preparation time were recorded. Corrected distance visual acuity (CDVA, logMAR) and central corneal thickness (CCT, µm) were collected preoperatively after 6 and 12 months, as well as postoperative complications, e.g., re-bubbling or repeat penetrating keratoplasty.
Surgical duration for Triple-DMEK and DMEK decreased significantly by 21 min and 14 min between the two periods ( < 0.001; < 0.001). Graft preparation time decreased significantly from 13.3 ± 5.2 min (95%CI 12.8-14.3) in period 1 to 10.7 ± 4.8 min (95%CI 10.2-11.4) in period 2 ( = 0.002). The postoperative changes in CDVA and CCT over both periods were not significant ( = 0.900; = 0.263). The re-bubbling rate decreased significantly from 51.2% in period 1 to 26.2% in period 2 ( < 0.001). The repeat penetrating keratoplasty (PKP) was 7.3% in period 1 and 3.7% in period 2 ( = 0.146). Re-DMEK was necessary in 6.1% in period 1 and 4.9% in period 2 ( = 0.535). Several parameters showed significant differences between the surgeons in both periods (surgical duration: period 1: < 0.001, period 2 < 0.001; graft preparation: period 1: < 0.001, period 2 < 0.001).
Significant decrease in surgery duration, graft preparation time, and the re-bubbling rate can be attributed to gained individual experience.
评估个体外科医生进行Descemet膜内皮角膜移植术（DMEK）和三联DMEK的学习曲线，并根据经验评估手术效果。
回顾性纳入四位外科医生各自的前41例和后41例手术。记录手术时间和植片准备时间。收集术前、术后6个月和12个月时的矫正远视力（CDVA，logMAR）和中央角膜厚度（CCT，µm），以及术后并发症，如再次注气或重复穿透性角膜移植术。
两个阶段之间，三联DMEK和DMEK的手术时间分别显著减少21分钟和14分钟（<0.001；<0.001）。植片准备时间从第1阶段的13.3±5.2分钟（95%CI 12.8 - 14.3）显著减少至第2阶段的10.7±4.8分钟（95%CI 10.2 - 11.4）（=0.002）。两个阶段中CDVA和CCT的术后变化均不显著（=0.900；=0.263）。再次注气率从第1阶段的51.2%显著降至第2阶段的26.2%（<0.001）。重复穿透性角膜移植术（PKP）在第1阶段为7.3%，在第2阶段为3.7%（=0.146）。再次进行DMEK在第1阶段为6.1%，在第2阶段为4.9%（=0.535）。两个阶段中，几位外科医生之间的几个参数均存在显著差异（手术时间：第1阶段：<0.001，第2阶段<0.001；植片准备：第1阶段：<0.001，第2阶段<0.001）。
手术时间、植片准备时间和再次注气率的显著降低可归因于个体经验的积累。
