Dong Xiaojuan, Ouyang Chen, Ye Qinying, Wu Jing, Xu Chenjia, Fu Lingling, Ma Minglu, Peng Jiayin, Huang Ting
From the State Key Laboratory of Ophthalmology (X.D., C.O., J.W., C.X., L.F., M.M., J.P., T.H.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
The Second Affiliated Hospital of Guangdong Medical University (Q.Y.), Zhanjiang, China.
Am J Ophthalmol. 2025 Feb;270:103-112. doi: 10.1016/j.ajo.2024.09.024. Epub 2024 Sep 27.
To investigate whether a recipient's entire Descemet stripping reduced endothelial cell loss (ECL) after Descemet membrane endothelial keratoplasty (DMEK) for iridocorneal endothelial (ICE) syndrome.
Randomized controlled clinical trial.
A total of 48 patients (48 eyes) with ICE syndrome were enrolled between 10 March 2014 and 11 May 11 2022. The eligible patients were divided into the entire recipient's Descemet stripping group (entire stripping group, 24 eyes) or the standard technique group (standard group, 24 eyes). DMEK was performed in all cases with concomitant procedures. The recipient's entire Descemet membrane or the central 8.0- or 8.25-mm diameter of the Descemet membrane was removed intraoperatively. Main outcome measures were ECL, corrected distance visual acuity (CDVA), intraocular pressure (IOP), graft survival, and surgical complications, which were compared 9, 12, and 24 months after surgery.
After a 9-month follow-up, ECL was significantly lower in the entire stripping group than in the standard group. At 2 years postoperatively, the ECL rate was 66% ± 5% and 74% ± 4% (95% CI: -0.04 to 0.01; P = .040), with a cumulative graft success rate of 83% and 67% (95% CI: -0.07 to 0.39; P = .318) in the entire stripping group and the standard group, respectively. The postoperative CDVA level was comparable between the 2 groups throughout the follow-up period. No significant differences between the 2 groups were observed in regard to the incidence of main complications.
Entire recipient's Descemet stripping may delay the pathological progression of ICE syndrome, thereby reducing ECL after DMEK.
探讨在虹膜角膜内皮（ICE）综合征患者行Descemet膜内皮角膜移植术（DMEK）后，受体全层Descemet膜剥除是否能减少内皮细胞丢失（ECL）。
随机对照临床试验。
2014年3月10日至2022年5月11日共纳入48例（48眼）ICE综合征患者。符合条件的患者被分为受体全层Descemet膜剥除组（全层剥除组，24眼）或标准技术组（标准组，24眼）。所有病例均行DMEK并伴有相关手术。术中切除受体全层Descemet膜或中央直径8.0或8.25mm的Descemet膜。主要观察指标为ECL、矫正远视力（CDVA）、眼压（IOP）、植片存活率和手术并发症，在术后9、12和24个月进行比较。
随访9个月后，全层剥除组的ECL明显低于标准组。术后2年，全层剥除组和标准组的ECL率分别为66%±5%和74%±4%（95%CI：-0.04至0.01；P = 0.040），累积植片成功率分别为83%和67%（95%CI：-0.07至0.39；P = 0.318）。在整个随访期间，两组术后CDVA水平相当。两组在主要并发症发生率方面未观察到显著差异。
受体全层Descemet膜剥除可能延缓ICE综合征的病理进展，从而减少DMEK术后的ECL。
