Ophthalmic Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Lombardy, Brescia, Italy.
Ophthalmic Unit, ASST Spedali Civili di Brescia, Lombardy, Brescia, Italy.
Acta Ophthalmol. 2024 Feb;102(1):e22-e30. doi: 10.1111/aos.15691. Epub 2023 May 8.
To compare the outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed after phacoemulsification and intraocular lens (IOL) implantation (sequential DMEK) and DMEK combined with phacoemulsification and IOL implantation (combined DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD) and cataract. Systematic literature review and meta-analysis performed according to the PRISMA guidelines and registered in PROSPERO. Literature searches were conducted in Medline and Scopus. Comparative studies reporting sequential DMEK and combined DMEK in FECD patients were included. The main outcome measure of the study was the corrected distance visual acuity (CDVA) improvement. Secondary outcomes were postoperative endothelial cell density (ECD), rebubbling rate and primary graft failure rate. Bias risk was assessed and a quality appraisal of the body of evidence was completed using the Cochrane Robin-I tool. A total of 667 eyes (5 studies) were included in this review, 292 eyes (43.77%) underwent a combined DMEK, while 375 (56.22%) eyes underwent a sequential DMEK surgery. We found no evidence of a difference between the two groups (mean difference, 95% CI) regarding: (1) CDVA improvement (-0.06; -0.14, 0.03 LogMAR; 3 studies, I : 0%; p = 0.86); (2) postoperative ECD (-62; -190, 67 cells/mm ; 4 studies, I : 67%; p = 0.35); (3) rebubbling (risks ratio: 1.04; 0.59, 1.85; 4 studies, I : 48%; p = 0.89); and primary graft failure rate (risks ratio: 0.91; 0.32, 2.57; 3 studies, I : 0%; p = 0.86). Of all the 5 non-randomized studies, all (100%) were graded as low quality. The overall quality of the analysed studies was low. Randomized controlled trials are needed to confirm no difference or superiority of one approach in terms of CDVA, endothelial cell count and postoperative complication rate between the two arms.
比较白内障超声乳化吸除联合人工晶状体植入术后行单纯后弹力层内皮角膜移植术（序贯 DMEK）与白内障超声乳化吸除联合人工晶状体植入术同期行单纯后弹力层内皮角膜移植术（联合 DMEK）治疗 Fuchs 角膜内皮营养不良（FECD）合并白内障患者的疗效。按照 PRISMA 指南进行系统文献回顾和荟萃分析，并在 PROSPERO 中注册。在 Medline 和 Scopus 中进行文献检索。纳入报告 FECD 患者行序贯 DMEK 与联合 DMEK 的比较研究。研究的主要观察指标为矫正视力（CDVA）改善。次要观察指标为术后内皮细胞密度（ECD）、再次注气率和原发性移植物失败率。评估偏倚风险，并使用 Cochrane Robiin-I 工具对证据体进行质量评估。本综述共纳入 667 只眼（5 项研究），其中 292 只眼（43.77%）行联合 DMEK，375 只眼（56.22%）行序贯 DMEK。我们未发现两组间存在差异（平均差异，95%CI）：（1）CDVA 改善（-0.06；-0.14，0.03 LogMAR；3 项研究，I²：0%；p=0.86）；（2）术后 ECD（-62；-190，67 个细胞/mm²；4 项研究，I²：67%；p=0.35）；（3）再次注气（风险比：1.04；0.59，1.85；4 项研究，I²：48%；p=0.89）；以及原发性移植物失败率（风险比：0.91；0.32，2.57；3 项研究，I²：0%；p=0.86）。5 项非随机研究均为低质量。分析研究的整体质量较低。需要开展随机对照试验来证实，在 CDVA、内皮细胞计数和术后并发症发生率方面，两种手术方式之间没有差异或一种方式不具有优势。
