Igarashi Ami, Takeda Masato, Mashiko Naoko, Shimizu Toshiki, Yuda Kentaro, Oie Yoshinori, Okumura Naoki, Yamaguchi Takefumi, Yamagami Satoru, Hayashi Takahiko
Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
Department of Ophthalmology, Yokohama Minami Kyosai Hospital, Yokohama, Japan.
Graefes Arch Clin Exp Ophthalmol. 2025 May;263(5):1373-1382. doi: 10.1007/s00417-025-06745-5. Epub 2025 Jan 25.
To investigate the correlation between intracellular dark endothelial spots (IDESs) detected by specular microscopy and the incidence of graft failure after Descemet's membrane endothelial keratoplasty (DMEK).
We reviewed 100 consecutive DMEK patients performed by a single surgeon at two centres between January 2015 and July 2022. Central corneal thickness was evaluated using anterior segment optical coherence tomography (SS-1000; Tomey, Aichi, Japan), and endothelial cell density was measured using specular microscopy. Kaplan-Meier estimates and Cox regression models were used to evaluate graft failure and associated risk factors.
Of the 97 eyes included, 9 experienced graft failure within the follow-up period (52.9 ± 23.9 months). IDES presence significantly correlated with decreased endothelial cell density and higher graft failure rates (hazard ratio = 4.68, 95% confidence interval = [0.96, 22.7], P = 0.034).
IDESs represent a significant risk factor for graft failure post-DMEK. Careful postoperative management is imperative to minimise this risk.
探讨镜面显微镜检查发现的细胞内暗区内皮斑（IDESs）与Descemet膜内皮角膜移植术（DMEK）后移植失败发生率之间的相关性。
我们回顾了2015年1月至2022年7月期间在两个中心由一名外科医生连续进行的100例DMEK患者。使用眼前节光学相干断层扫描（SS - 1000；日本爱知县拓普康）评估中央角膜厚度，并使用镜面显微镜测量内皮细胞密度。采用Kaplan - Meier估计法和Cox回归模型评估移植失败及相关危险因素。
在纳入的97只眼中，9只在随访期内发生移植失败（52.9±23.9个月）。IDES的存在与内皮细胞密度降低和移植失败率升高显著相关（风险比 = 4.68，95%置信区间 = [0.96, 22.7]，P = 0.034）。
IDESs是DMEK后移植失败的一个重要危险因素。必须进行仔细的术后管理以将此风险降至最低。
