Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany.
Industrial and Organizational Psychology, Saarland University, Saarbruecken, Germany; and.
Cornea. 2024 Jul 1;43(7):844-852. doi: 10.1097/ICO.0000000000003423. Epub 2023 Nov 7.
The aim of this study was to investigate differences between phakic, pseudophakic, and scarred stromal donor tissue for their influence on complication rates during preparation or implantation and on the postoperative outcome of Descemet membrane endothelial keratoplasty (DMEK).
We retrospectively compared 484 eyes undergoing DMEK, divided into 3 subgroups of donor tissue (1: phakic, 2: pseudophakic, and 3: scarred stromal). Visual acuity, central corneal thickness (CCT), and endothelial cell count were monitored preoperatively and postoperatively at 6 weeks and 3, 6, 12, and 24 months. The incidence of intraoperative and postoperative complications was analyzed.
The risk of adherence and tearing during preparation was significantly higher in group 2 than in the other groups (p's < 0.001). No significant difference was found for visual acuity (p's ≥ 0.368) and long-term CCT, but CCT recovery took longer in group 2 (P = 0.003), normalizing after 3 months (p's ≥ 0.096). The overall mean endothelial cell count was lower in group 2 compared with the other groups (P = 0.011). No difference in the rebubbling rate was detected (P = 0.890). However, the risk of repeat keratoplasty for phakic grafts was lower compared with group 2 (P = 0.008).
Pseudophakic donor grafts are more difficult to prepare and implant, resulting in longer recovery times and a higher risk of graft failure. However, when the preparation is uneventful and no graft failure occurs, pseudophakic grafts show a comparable outcome. Given the shortage of corneal donors and the high prevalence of pseudophakic corneal donors, they should not generally be excluded from corneal donation for DMEK.
本研究旨在探讨正常眼、人工晶状体眼和瘢痕化基质供体组织之间的差异，以研究其对准备或植入过程中并发症发生率以及后弹力膜内皮角膜移植术（DMEK）术后结果的影响。
我们回顾性比较了 484 只接受 DMEK 的眼，分为 3 组供体组织（1：正常眼，2：人工晶状体眼，3：瘢痕化基质）。分别于术前、术后 6 周以及术后 3、6、12 和 24 个月监测视力、中央角膜厚度（CCT）和内皮细胞计数。分析术中及术后并发症的发生率。
与其他两组相比，在准备过程中 2 组粘连和撕裂的风险显著更高（p 值均＜0.001）。视力（p 值均≥0.368）和长期 CCT 无显著差异，但 2 组 CCT 恢复时间较长（P = 0.003），术后 3 个月恢复正常（p 值均≥0.096）。与其他两组相比，2 组总的平均内皮细胞计数较低（P = 0.011）。再灌流率无差异（P = 0.890）。然而，与 2 组相比，正常眼供体移植物的再次移植风险较低（P = 0.008）。
人工晶状体眼供体移植物较难准备和植入，导致恢复时间延长，移植物失败风险增加。然而，只要准备过程顺利且移植物未失败，人工晶状体眼供体移植物的结果可与之相媲美。鉴于角膜供体短缺和人工晶状体眼供体角膜的高患病率，一般不应将其排除在 DMEK 角膜供体之外。
