Bayyoud Tarek, Bartz-Schmidt Karl Ulrich, Rohrbach Martin, Gelisken Faik, Goldblum David, Martus Peter, Thaler Sebastian
Department of Ophthalmology, University Hospital of Tübingen, Tübingen, 72076, Germany.
Ophthalmology, Pallas Kliniken (Olten-Bern-Zürich-Aargau), Olten, 4600, Switzerland.
Clin Ophthalmol. 2025 Apr 13;19:1277-1288. doi: 10.2147/OPTH.S509682. eCollection 2025.
To assess clinical outcomes after Descemet's Membrane Endothelial Keratoplasty (DMEK) with mydriatic eye drops without peripheral iridotomy (PI-less). We performed a retrospective, observational clinical study to determine the postoperative intraocular pressure (IOP) changes and graft viability in a cohort of patients with Fuchs' endothelial corneal dystrophy (FECD) and bullous keratopathy (BK).
Included in this study were 41 PI-less DMEK patients with 44 eyes (median age: 77 years; range: 53-88 years). Patients received either PI-less DMEK (group-1) or PI-less triple DMEK (group-2). The mean follow-up duration was 16 months. Eyes after standard DMEK or triple DMEK served as controls (n = 20). Included in the study were patients admitted to the hospital (securing IOP control), patients in which the tamponading agent was air or gas (SF6) and only patients with physiological air resorption, ie without routine, postoperative air/gas release (90% air/gas fill of the anterior chamber at end of surgery). Phakic eyes were not included. Postoperatively, mydriatic eye drops were administered for three days 4x/d (phenylephrine 25 mg/mL, tropicamide 5 mg/mL). The best-corrected visual acuity (BCVA), endothelial cell density (ECD), and IOP were assessed. Intra- and postoperative complications and management were recorded.
BCVA improved significantly in both groups (group-1:0.90 ± 0.57 to 0.20 ± 0.23logMAR (p = 0.000); group-2:0.47 ± 0.23 to 0.17 ± 0.42logMAR (p = 0.0067). ECD decreased significantly: Group-1 2428±225 cells/mm to 1810±236 cells/mm (p = 0.005); group-2 2447 ± 178 cells/mm to 1866 ± 229 cells/mm (p = 0.012). After postoperative day-1 IOP decreased significantly: Group-1 p = 0.004 (10.0 ± 2.8 mmHg) and p = 0.002 (11.3 ± 3.1 mmHg); group-2 p = 0.002 (10.7 ± 3.6 mmHg) and p = 0.002 (11.4 ± 2.2 mmHg); for postoperative days 2 and 3, respectively. Postoperative adverse events included pupillary block necessitating emergency air release. Intergroup analysis did not show a significant difference in ECD, IOP (after postoperative day-1) and logMAR (after 6 months).
Patients may benefit from the promising results of the study regarding postoperative IOP developments and graft viability after DMEK using mydriatic eye drops (phenylephrine 25 mg/mL, tropicamide 5 mg/mL). PI-less triple DMEK in particular might improve accessibility, reduce surgical complexity, or lower costs, making it attractive in resource-limited settings. Close postoperative IOP monitoring is advised in PI-less DMEKs.
评估使用散瞳滴眼液且不进行周边虹膜切开术（无周边虹膜切开术）的Descemet膜内皮角膜移植术（DMEK）后的临床结果。我们进行了一项回顾性观察性临床研究，以确定一组患有Fuchs内皮角膜营养不良（FECD）和大疱性角膜病变（BK）的患者术后的眼压（IOP）变化和移植物存活率。
本研究纳入了41例接受无周边虹膜切开术DMEK的患者，共44只眼（中位年龄：77岁；范围：53 - 88岁）。患者接受无周边虹膜切开术DMEK（第1组）或无周边虹膜切开术三联DMEK（第2组）。平均随访时间为16个月。标准DMEK或三联DMEK术后的眼睛作为对照（n = 20）。纳入研究的患者为入院患者（确保眼压得到控制），使用空气或气体（SF6）作为填塞剂的患者，且仅为生理性空气吸收的患者，即术后无需常规进行空气/气体释放（手术结束时前房90%填充空气/气体）。有晶状体眼不包括在内。术后，使用散瞳滴眼液（去氧肾上腺素25mg/mL，托吡卡胺5mg/mL），每天4次，共3天。评估最佳矫正视力（BCVA）、内皮细胞密度（ECD）和眼压。记录术中及术后并发症及处理情况。
两组的BCVA均显著改善（第1组：从0.90±0.57提高到0.20±0.23logMAR（p = 0.000）；第2组：从0.47±0.23提高到0.17±0.42logMAR（p = 0.0067）。ECD显著下降：第1组从2428±225个细胞/mm²降至1810±236个细胞/mm²（p = 0.005）；第2组从2447±178个细胞/mm²降至1866±229个细胞/mm²（p = 0.012）。术后第1天之后眼压显著下降：第1组p = 0.004（10.0±2.8mmHg）和p = 0.002（11.3±3.1mmHg）；第2组p = 0.002（10.7±3.6mmHg）和p = 0.002（11.4±2.2mmHg），分别对应术后第2天和第3天。术后不良事件包括瞳孔阻滞，需要紧急释放空气。组间分析显示，ECD、眼压（术后第1天之后）和logMAR（6个月后）无显著差异。
患者可能会从本研究关于使用散瞳滴眼液（去氧肾上腺素25mg/mL，托吡卡胺5mg/mL）的DMEK术后眼压变化和移植物存活率的有前景的结果中获益。特别是无周边虹膜切开术三联DMEK可能会提高手术可及性、降低手术复杂性或降低成本，使其在资源有限的环境中具有吸引力。建议对无周边虹膜切开术DMEK术后进行密切的眼压监测。
