地形热点对DMEK联合白内障手术屈光结果的影响。

Impact of topographic hot spots on the refractive outcomes of combined DMEK and cataract surgery.

作者信息

Rotfogel Ziv, Pellegrini Marco, Franco Elena, Zauli Giorgio, Yu Angeli Christy, Busin Massimo

机构信息

From the Department of Ophthalmology, Ospedali Privati Forlì "Villa Igea," Forlì, Italy (Rotfogel, Pellegrini, Franco, Yu, Busin); Ophthalmology Research Laboratory, Kaplan Medical Center, Rehovot, Israel (Rotfogel); Faculty of Medicine, Hadassah Medical School, The Hebrew University, Jerusalem, Israel (Rotfogel); Department of Translational Medicine, University of Ferrara, Ferrara, Italy (Pellegrini, Yu, Busin); Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy (Pellegrini, Franco, Yu, Busin); Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia (Zauli).

出版信息

J Cataract Refract Surg. 2023 Aug 1;49(8):848-852. doi: 10.1097/j.jcrs.0000000000001192.

DOI:10.1097/j.jcrs.0000000000001192

PMID:37052155

Abstract

PURPOSE

To compare the refractive results of combined Descemet membrane endothelial keratoplasty (DMEK) and cataract surgery in eyes with Fuchs endothelial corneal dystrophy (FECD) with and without topographic hot spots.

SETTING

"Villa Igea" Hospital, Forlì, Italy.

DESIGN

Interventional case series.

METHODS

57 eyes of 52 patients with FECD undergoing combined DMEK, cataract surgery, and monofocal intraocular lens (IOL) implantation were included in this single-center study. Patients were classified based on the presence or absence of topographic hot spots on the preoperative axial power map. Prediction error (PE) was calculated as the postoperative manifest spherical equivalent (SE) refraction minus the SE predicted refraction.

RESULTS

6 months postoperatively, mean PE was +0.79 ± 1.12 diopters (D). In eyes with hot spots, mean keratometry (K), K flat, and K steep significantly decreased after surgery (all P < .05), whereas no significant changes were observed in eyes without hot spots (all P > .05). Eyes with hot spots showed a significantly more hyperopic PE than eyes without hot spots (+1.13 ± 1.23 vs +0.40 ± 0.86 D; P = .013).

CONCLUSIONS

Combined DMEK and cataract surgery can result in a hyperopic refractive surprise. The presence of topographic hot spots before surgery is associated with a higher hyperopic shift.

摘要

目的

比较合并或不合并地形图热点的Fuchs内皮角膜营养不良（FECD）患者行Descemet膜内皮角膜移植术（DMEK）联合白内障手术的屈光结果。

设置

意大利弗利“Villa Igea”医院。

设计

干预性病例系列。

方法

本单中心研究纳入了52例接受DMEK联合白内障手术及单焦点人工晶状体（IOL）植入的FECD患者的57只眼。根据术前轴向屈光度图上是否存在地形图热点对患者进行分类。预测误差（PE）计算为术后明显球镜等效度（SE）屈光减去预测的SE屈光。

结果

术后6个月，平均PE为+0.79±1.12屈光度（D）。有热点的眼中，术后平均角膜曲率（K）、平坦K值和陡峭K值显著降低（均P<.05），而无热点的眼中未观察到显著变化（均P>.05）。有热点的眼比无热点的眼表现出明显更高的远视性PE（+1.13±1.23 vs +0.40±0.86 D；P=.013）。