Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, United Kingdom.
National Institute for Health Research Biomedical Research Centre for Ophthalmology Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom.
Indian J Ophthalmol. 2023 Mar;71(3):707-716. doi: 10.4103/ijo.IJO_1245_22.
This review aimed to compare the outcomes of Descemet's membrane endothelial keratoplasty (DMEK) in combination with (category 1), before (category 2), or after cataract surgery (category 3) in patients with Fuchs' endothelial dystrophy (FED). Primary outcome was gain in best-corrected log of minimum angle of resolution (logMAR) visual acuity (BCVA). Secondary outcomes were graft detachment, rebubbling rates, rejection, failure, and endothelial cell loss (ECL). In category 1, 2, and 3, 12 studies (N = 1932) were included (five in category 1 [n = 696], one in category 2 [n = 286], and two in category 3 [n = 950], and the remaining four compared between two of the three categories). At 6 months, the gain in BCVA was 0.34 ± 0.04, 0.25 ± 0.03, and 0.38 ± 0.03 logMAR in category 1, 2, and 3, respectively. The difference was significant between categories 1 and 2 (Chi = 11.47, P < 0.01) and categories 2 and 3 (Chi = 35.53, P < 0.01). At 12 months, the gain in BCVA was 0.52 ± 0.05 and 0.38 ± 0.06 logMAR in categories 1 & 3 (Chi = 14.04, P < 0.01). The rebubbling rates were 15%, 4%, and 10% (P < 0.01) and the graft detachment rates were 31%, 8%, and 13% (P < 0.01) in categories 1, 2, and 3, respectively. However, graft rejection, survival rates, and ECL at 12 months were not different between categories 1 and 3. There is low certainty evidence that gain in BCVA in category 1 was comparable to category 3 at 6 months; however, it was significantly better with category 3 at 12 months. Although rebubbling and graft detachment rates were highest in category 1, there was no significant difference in graft rejection, survival rates, and ECL. Further high-quality studies are likely to change the effect estimate and have an impact on the confidence of the estimate.
本综述旨在比较在 Fuchs 内皮营养不良（FED）患者中，行后弹力层内皮角膜移植术（DMEK）时联合白内障手术（1 类）、白内障手术之前（2 类）或白内障手术之后（3 类）的结局。主要结局为最佳矫正视力（BCVA）对数最小分辨角视力（logMAR）的提高。次要结局为植片脱离、再次注气率、排斥反应、失败和内皮细胞丢失（ECL）。1 类、2 类和 3 类分别纳入 12 项研究（N=1932）（5 项 1 类[696 例]，1 项 2 类[286 例]，2 项 3 类[950 例]，另外 4 项研究比较了 3 类中的 2 类）。6 个月时，1 类、2 类和 3 类的 BCVA 提高分别为 0.34±0.04、0.25±0.03 和 0.38±0.03 logMAR。1 类与 2 类（卡方=11.47，P＜0.01）和 2 类与 3 类（卡方=35.53，P＜0.01）之间的差异具有统计学意义。12 个月时，1 类和 3 类的 BCVA 提高分别为 0.52±0.05 和 0.38±0.06 logMAR（卡方=14.04，P＜0.01）。再次注气率分别为 15%、4%和 10%（P＜0.01），植片脱离率分别为 31%、8%和 13%（P＜0.01）。然而，12 个月时的植片排斥反应、存活率和 ECL 在 1 类和 3 类之间无差异。有低质量证据表明，6 个月时 1 类的 BCVA 提高与 3 类相当，但 12 个月时 3 类明显更好。虽然 1 类的再次注气率和植片脱离率最高，但植片排斥反应、存活率和 ECL 无显著差异。进一步的高质量研究可能会改变效应估计，并对估计的可信度产生影响。
