Mechleb Nicole, Barresi Costanza, Caputo Georges, Saad Alain, Abdelmassih Youssef
Department of Ophthalmology, Rothschild Foundation Hospital, Paris, France.
CEROV: Center of Expertise and Research in Visual Optics, Paris, France.
Graefes Arch Clin Exp Ophthalmol. 2025 May;263(5):1365-1371. doi: 10.1007/s00417-024-06700-w. Epub 2024 Nov 28.
To describe the incidence of CME in re-DMEK procedures and identify the associated risk factors.
Retrospective case series of 88 patients who underwent re-DMEK surgeries from January 2013 to October 2023. Surgical results were analyzed based on the cause of corneal decompensation, associated ophthalmologic factors, occurrence of CME after primary DMEK surgery, incidence of CME after re-DMEK, time interval between surgery and onset of CME, and management and outcomes of CME.
Primary DMEK indications were Fuchs endothelial corneal dystrophy (FECD) in 40 eyes (44.9%), PBK in 30 eyes (33.7%) and herpes simplex virus (HSV) in 10 eyes (11.2%). After the first DMEK surgery, CME occurred in 16 eyes (18%) with a mean interval of 23.4 ± 16.7 weeks. After re-DMEK surgery, CME occurred in 22.5% with a mean interval of 14.2 ± 21.9 weeks. It was a new onset in 13 eyes (65%), recurrent in 6 eyes (30%), and persistent in 1 eye (5%). On multivariate analysis, no significant association was found between the presence of ERM and CME following re-DMEK. Eyes with a history of PPV and prior CME were significantly associated with CME occurrence with odd ratios of 4.9 (95% CI: 1.04-23.1, p = 0.04) and 4.1 (95%CI: 1.2-13.5, p = 0.02) respectively.
CME following re-DMEK occurs in 22.5% of cases, primarily within the first three months post-operatively. The main risk factors include a previous occurrence of CME after the initial DMEK and a history of PPV. However, CME does not seem to negatively impact the final visual outcomes of re-DMEK.
描述重复Descemet膜内皮角膜移植术（re-DMEK）中角膜基质水肿（CME）的发生率，并确定相关危险因素。
回顾性病例系列研究，纳入2013年1月至2023年10月期间接受re-DMEK手术的88例患者。根据角膜失代偿原因、相关眼科因素、初次DMEK手术后CME的发生情况、re-DMEK后CME的发生率、手术至CME发作间隔时间以及CME的处理和结局对手术结果进行分析。
初次DMEK的适应证为40眼（44.9%）的Fuchs内皮角膜营养不良（FECD）、30眼（33.7%）的周边板层角膜白斑（PBK）和10眼（11.2%）的单纯疱疹病毒（HSV）感染。初次DMEK手术后，16眼（18%）发生CME，平均间隔时间为23.4±16.7周。re-DMEK手术后，22.5%的患者发生CME，平均间隔时间为14.2±21.9周。其中13眼（65%）为新发，6眼（30%）为复发，1眼（5%）为持续存在。多因素分析显示，re-DMEK后视网膜前膜（ERM）的存在与CME之间无显著相关性。有玻璃体切割术（PPV）病史和既往CME病史的眼与CME发生显著相关，比值比分别为4.9（95%CI：1.04-23.1，p=0.04）和4.1（95%CI：1.2-13.5，p=0.02）。
re-DMEK后22.5%的病例发生CME，主要发生在术后前三个月内。主要危险因素包括初次DMEK后既往发生过CME和PPV病史。然而，CME似乎并未对re-DMEK的最终视力结果产生负面影响。
