De-Arriba-Palomero Pablo, Mingo-Botín David, Etxebarría-Ecenarro Jaime, Celis Javier, Merino-Diez María Teresa, García-Tomás Cristina, Stokking Martha, Álvarez de Toledo Juan, Muñoz-Negrete Francisco J, Arnalich-Montiel Francisco
Department of Ophthalmology, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo Km 9, 100, Madrid, 28034, Spain.
Doctoral School, Alcalá de Henares University, Madrid, Spain.
Sci Rep. 2025 May 2;15(1):15423. doi: 10.1038/s41598-025-99324-x.
To demonstrate that enoxaparin in the irrigation saline solution can effectively prevent intraoperative fibrin formation (IFF) during Descemet membrane endothelial keratoplasty (DMEK) surgery without compromising graft viability, visual recovery, or intraoperative safety. A "before-and-after" study was conducted, comparing the rate of IFF in a prospective cohort of DMEK cases treated with enoxaparin to a retrospective cohort without treatment. Donor cornea characteristics, surgical data, rebubbling rate, final endothelial cell density (ECD), and best corrected visual acuity (BCVA) were analyzed. A total of 265 cases were analyzed. The incidence of IFF was 5.43% in the cohort without enoxaparin and zero in the enoxaparin-treated cohort. The risk ratio for enoxaparin use was 0 (confidence interval: 0), with a risk difference of -0.054 and a number needed to treat (NNT) of 18.42 cases to prevent one IFF event. No significant differences were found in baseline patients features or surgical aspects. The rebubbling rate was 16.98%, with no statistically significant difference between groups. No significant differences were observed in final ECD or BCVA between groups. In addition, no intraoperative complications or intraocular bleeding occurred with enoxaparin administration. Enoxaparin is a safe, effective, and cost-efficient prophylaxis for preventing IFF during DMEK surgery. It impedes the development of IFF, which may require a new and costly transplant when it occurs.
为证明在灌注盐溶液中加入依诺肝素可有效预防角膜后弹力层内皮移植术（DMEK）手术期间的术中纤维蛋白形成（IFF），同时不影响移植物的存活、视力恢复或术中安全性。进行了一项“前后”研究，比较了接受依诺肝素治疗的DMEK病例前瞻性队列与未治疗的回顾性队列中的IFF发生率。分析了供体角膜特征、手术数据、再次注气率、最终内皮细胞密度（ECD）和最佳矫正视力（BCVA）。共分析了265例病例。未使用依诺肝素的队列中IFF发生率为5.43%，而依诺肝素治疗队列中为零。使用依诺肝素的风险比为0（置信区间：0），风险差为-0.054，预防一例IFF事件所需治疗人数（NNT）为18.42例。在基线患者特征或手术方面未发现显著差异。再次注气率为16.98%，两组之间无统计学显著差异。两组之间在最终ECD或BCVA方面未观察到显著差异。此外，使用依诺肝素未发生术中并发症或眼内出血。依诺肝素是预防DMEK手术期间IFF的一种安全、有效且经济高效的预防措施。它可阻止IFF的发生，IFF发生时可能需要进行新的且昂贵的移植。
