Ophthalmology Department, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France.
Research Support Unit, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France.
PLoS One. 2023 Mar 3;18(3):e0282594. doi: 10.1371/journal.pone.0282594. eCollection 2023.
Descemet membrane endothelial keratoplasty (DMEK) restores visual acuity in patients with progressive corneal endothelial diseases such as Fuchs endothelial corneal dystrophy (FECD). However, patients often prefer to delay the surgery as long as possible, even though outcomes are poorer in advanced FECD. A recent study proposed that preoperative central corneal thickness (CCT) of ≥625 μm associated with worse best spectacle-corrected visual acuity (BSCVA) after DMEK for FECD. Since this threshold could signal to both surgeons and patients when to perform DMEK, we further explored the relationship between CCT and BSCVA with a retrospective cohort study. The cohort consisted of all patients with FECD who underwent DMEK in a tertiary-care hospital in 2015-2020 and were followed for 12 months. Extremely decompensated corneas were not included. Relationships between preoperative CCT and BSCVA on days 8 and 15 and months 1, 3, 6, and 12 were examined with Pearson correlation analyses. Eyes with preoperative CCT <625 or ≥625 μm were also compared in terms of postoperative BSCVA. Relationships between postoperative CCT and final BSCVA were also explored. The cohort consisted of 124 first-operated eyes. Preoperative CCT did not correlate with postoperative BSCVA at any timepoint. Eye subgroups did not differ in postoperative BSCVA. However, postoperative CCT at 1-12 months correlated significantly with 12-month BSCVA (r = 0.29-0.49, p = 0.020-0.001). Thus, postoperative, but not preoperative, CCT correlated with postoperative BSCVA. This phenomenon may reflect factors that distort preoperative CCT measurements but disappear after surgery. This observation and our analysis of the literature suggest that while there is a relationship between CCT and post-DMEK visual acuity, preoperative CCT measurements may not always adequately reflect that relationship and may therefore not be a reliable predictor of DMEK visual outcomes.
Descemet 膜内皮角膜移植术 (DMEK) 可恢复进展性角膜内皮疾病（如 Fuchs 角膜内皮营养不良）患者的视力。然而，即使在晚期 FECD 中，手术效果也较差，患者通常仍希望尽可能推迟手术。最近的一项研究表明，术前中央角膜厚度（CCT）≥625μm 与 FECD 行 DMEK 后最佳矫正视力（BCVA）较差相关。由于这个阈值可以向外科医生和患者发出信号，提示何时进行 DMEK，我们进一步通过回顾性队列研究探讨了 CCT 与 BCVA 的关系。该队列纳入了 2015 年至 2020 年在一家三级医院接受 DMEK 的所有 FECD 患者，随访时间为 12 个月。不包括极度失代偿的角膜。使用 Pearson 相关分析检查术前 CCT 与术后第 8 天、第 15 天及术后第 1、3、6 和 12 个月的 BCVA 之间的关系。比较术前 CCT＜625μm 或≥625μm 的眼术后 BCVA。还探讨了术后 CCT 与最终 BCVA 的关系。该队列纳入了 124 只初次手术眼。术前 CCT 与任何时间点的术后 BCVA 均无相关性。术后 BCVA 在眼亚组之间无差异。然而，术后 1-12 个月的 CCT 与 12 个月的 BCVA 显著相关（r=0.29-0.49，p=0.020-0.001）。因此，术后 CCT 与术后 BCVA 相关，而术前 CCT 则不相关。这种现象可能反映了扭曲术前 CCT 测量的因素，但在手术后消失。这一观察结果和我们对文献的分析表明，尽管 CCT 与 DMEK 术后视力之间存在相关性，但术前 CCT 测量值可能并不总是充分反映这种相关性，因此可能不是 DMEK 视力结果的可靠预测指标。
