Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden.
Division of Ophthalmology and Vision, Department of Clinical Neuroscience, Karolinska Institutet, St. Erik Eye Hospital, Stockholm, Sweden.
Ophthalmology. 2023 Dec;130(12):1248-1257. doi: 10.1016/j.ophtha.2023.07.024. Epub 2023 Jul 28.
To compare the outcome between posterior lamellar corneal transplant procedures for Fuchs endothelial corneal dystrophy, taking preoperative patient characteristics in consideration. Surgical methods compared were Descemet membrane endothelial keratoplasty (DMEK), Descemet stripping automated endothelial keratoplasty (DSAEK), and DSAEK with concomitant cataract surgery (phacoemulsification plus DSAEK).
Registry-based study with propensity score matching.
One thousand six hundred seventy-seven patients from all Swedish corneal transplantation units treated from 2012 through 2019.
All patients undergoing endothelial keratoplasty performed from 2012 through 2019 with completed 2-year follow-up data reported to The Swedish Corneal Transplant Register were included, totaling 1677 patients. Three comparable groups (DMEK, DSAEK, and phacoemulsification plus DSAEK) with 216 patients in each group were generated with propensity score matching based on preoperative visual acuity, age, sex, year of surgery, and preoperative risk factors such as inflammation, vascularization, and glaucoma.
Best-corrected visual acuity (BCVA) at the 2-year follow-up, frequency of graft dislocation, graft rejection episodes, and graft failure within 2 years including primary graft failure.
The preoperative corneal status was affected more severely in the DSAEK group before matching. In the matched groups, the median BCVA 2 years after surgery was 0.1 logarithm of the minimum angle of resolution (logMAR) in both the DMEK and the phacoemulsification plus DSAEK groups and 0.15 logMAR in the DSAEK group (P = 0.001). The frequency of graft dislocation was higher among the patients undergoing phacoemulsification plus DSAEK, but the frequency of graft failure and primary graft failure was higher in the DMEK group.
Visual acuity improved in most patients (90%) with all 3 surgical methods. However, DMEK and phacoemulsification plus DSAEK reached higher levels of visual acuity 2 years after surgery, and phacoemulsification plus DSAEK was superior considering graft survival rate. All 3 surgical procedures showed both strengths and weaknesses, suggesting that the choice of surgical method should be individualized, taking into consideration not only the cornea, but each patient's complete medical status as well as the entire course of postoperative medical care.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
考虑术前患者特征，比较用于 Fuchs 内皮角膜营养不良的后板层角膜移植术的结果。比较的手术方法包括 Descemet 膜内皮角膜移植术（DMEK）、Descemet 膜撕除自动化内皮角膜移植术（DSAEK）和伴有白内障手术的 DSAEK（超声乳化术加 DSAEK）。
基于倾向评分匹配的登记研究。
2012 年至 2019 年期间，来自所有瑞典角膜移植单位的 1677 名患者。
纳入 2012 年至 2019 年期间行内皮角膜移植术且报告了 2 年随访数据的所有患者，总计 1677 例患者。根据术前视力、年龄、性别、手术年份以及炎症、血管化和青光眼等术前危险因素，基于倾向评分匹配，生成了 3 个可比组（DMEK、DSAEK 和超声乳化术加 DSAEK），每组 216 例患者。
术后 2 年最佳矫正视力（BCVA）、移植物脱位频率、移植物排斥发作和 2 年内包括原发性移植物失功在内的移植物失败。
匹配前 DSAEK 组的术前角膜状态更严重。在匹配组中，DMEK 和超声乳化术加 DSAEK 组术后 2 年的中位 BCVA 均为 0.1 对数最小角分辨率（logMAR），DSAEK 组为 0.15 logMAR（P=0.001）。行超声乳化术加 DSAEK 的患者移植物脱位频率较高，但 DMEK 组的移植物失败和原发性移植物失败频率较高。
大多数（90%）患者通过 3 种手术方法视力均有所提高。然而，DMEK 和超声乳化术加 DSAEK 在术后 2 年达到更高的视力水平，且考虑到移植物存活率，超声乳化术加 DSAEK 更具优势。所有 3 种手术方法都有各自的优缺点，这表明手术方法的选择应该个体化，不仅要考虑角膜，还要考虑每位患者的完整医疗状况以及整个术后医疗护理过程。
作者无任何与本文讨论的材料相关的专有或商业利益。
