Tourabaly Moïse, Knoeri Juliette, Georgeon Cristina, Borderie Vincent
Centre Hospitalier National d'Ophtalmologie des 15-20, GRC32 Sorbonne Université, 28 rue de Charenton, 75571 Paris, France.
J Clin Med. 2025 Mar 29;14(7):2365. doi: 10.3390/jcm14072365.
To provide an overview of the preoperative indications for endothelial graft in patients with Fuchs endothelial corneal dystrophy (FECD). A comprehensive database search without date restrictions was performed in PubMed. Keywords included Descemet membrane endothelial keratoplasty (DMEK), Descemet stripping automated endothelial keratoplasty (DSAEK), corneal keratoplasty, preoperative visual acuity, preoperative central corneal thickness, and densitometry. Articles aiming to describe or evaluate preoperative indications for endothelial keratoplasty were considered eligible and were included in this review. The indications for surgery in FECD are disparate between the different studies. The tendency is to operate on patients earlier to obtain a better postoperative visual acuity at 1 year. The surgical decision is based on a number of arguments (visual acuity, CCT, densitometry). A preoperative visual acuity worse than 20/40 is generally considered a surgical indication for DMEK, based on current literature. Surgical decisions for Fuchs' dystrophy should be individualized, guided by preoperative visual acuity, corneal OCT, and advanced imaging, with future risk scores potentially refining the timing of intervention to optimize outcomes.
概述富克斯内皮性角膜营养不良（FECD）患者内皮移植的术前指征。在PubMed上进行了无日期限制的全面数据库搜索。关键词包括后弹力层内皮角膜移植术（DMEK）、后弹力层剥除自动内皮角膜移植术（DSAEK）、角膜移植术、术前视力、术前中央角膜厚度和密度测定。旨在描述或评估内皮角膜移植术前指征的文章被认为符合要求并纳入本综述。不同研究中FECD的手术指征各不相同。趋势是更早地对患者进行手术，以便在1年后获得更好的术后视力。手术决策基于多种因素（视力、中央角膜厚度、密度测定）。根据当前文献，术前视力低于20/40通常被认为是DMEK的手术指征。对于富克斯营养不良的手术决策应个体化，以术前视力、角膜OCT和先进成像为指导，未来的风险评分可能会优化干预时机以实现最佳结果。
