Cuadrado Alberto Villarrubia, Sánchez-Ventosa Álvaro, González-Cruces Timoteo, Díaz-Mesa Vanessa, Villalva-González Marta, Miranda Elisa Palacín, López Pérez María Dolores, Pérez-Angulo Javier Gersol, Díaz-Ramos José Carlos, Cano-Ortiz Antonio
Department of Anterior Segment, Cornea and Refractive Surgery, Hospital Arruzafa, Córdoba, Spain.
Department of Health and Biomedical Sciences, Loyola University of Andalusia, Seville, Spain.
Graefes Arch Clin Exp Ophthalmol. 2025 May 5. doi: 10.1007/s00417-025-06747-3.
Descemet Stripping Only (DSO) is a minimally invasive procedure for Fuchs' Endothelial Corneal Dystrophy (FECD) that leverages peripheral endothelial regeneration without donor tissue. This study evaluates visual and anatomical outcomes of DSO and the role of guttae distribution in recovery.
A prospective study included 30 eyes of FECD patients undergoing DSO. Patients were classified by guttae distribution: type A (central) or type B (0º-180º meridian). Preoperative and postoperative outcomes, including corrected distance visual acuity (CDVA), central corneal thickness (CCT), and endothelial cell density (ECD), were assessed over 12 months.
Of 26 patients completing follow-up, 42.31% achieved a CDVA ≥ 0.22 logMAR by week 4, and 84.62% by month 12. Type B patients recovered faster, reaching CDVA ≥ 0.10 logMAR in 56 days versus 112 days for type A. Mean CCT improved from 606.96 ± 60.97 μm to 550.40 ± 29.67 μm (p = 0.0001). Postoperative ECD averaged 1402.7 ± 130.56 cells/mm². Corneal densitometry improved significantly but remained higher than controls.
DSO is an effective treatment for FECD with adequate peripheral endothelial reserve. Guttae distribution affects recovery speed, but final outcomes are similar. If no improvement occurs by the third month, a rescue DMEK is effective. Keratometry remains unchanged, epithelial thickness slightly increases, and corneal densitometry improves postoperatively.
What is know: DSO is a donor-free surgical option for endothelial dystrophies like Fuchs' dystrophy, utilizing the eye's natural endothelial regenerative capacity in selected patients. Success relies on residual endothelial cell density and biomarkers like preoperative corneal thickness to predict regeneration outcomes.
Pattern of guttae distribution influences recovery timeline in DSO: Patients with type B guttae distribution (0º-180º meridian) achieve a CDVA of 0.1 logMAR faster than those with type A (central guttae), though finalvisual acuity, pachymetry, and endothelial cell density are similar at 12 months. DSO as an effective treatment for fuchs' endothelial corneal dystrophy: Descemet stripping only achieves corneal clearance in most cases within 3-4 months, with significant CDVA and quality of life improvements (NEI VFQ-25 scores), supporting its role as a minimally invasive alternative to donor graft surgeries.
仅行后弹力层剥除术（DSO）是一种针对富克斯内皮性角膜营养不良（FECD）的微创手术，该手术利用周边内皮再生，无需使用供体组织。本研究评估了DSO的视力和解剖学结果以及角膜小滴分布在恢复过程中的作用。
一项前瞻性研究纳入了30例接受DSO的FECD患者的眼睛。患者根据角膜小滴分布进行分类：A型（中央型）或B型（0°至180°子午线型）。在12个月内评估术前和术后结果，包括矫正远视力（CDVA）、中央角膜厚度（CCT）和内皮细胞密度（ECD）。
在完成随访的26例患者中，42.31%在第4周时CDVA≥0.22 logMAR，12个月时为84.62%。B型患者恢复更快，达到CDVA≥0.10 logMAR的时间为56天，而A型患者为112天。平均CCT从606.96±60.97μm改善至550.40±29.67μm（p = 0.0001）。术后ECD平均为1402.7±130.56个细胞/mm²。角膜密度测量有显著改善，但仍高于对照组。
对于有足够周边内皮储备的FECD，DSO是一种有效的治疗方法。角膜小滴分布影响恢复速度，但最终结果相似。如果在第三个月时没有改善，挽救性的深板层角膜内皮移植术（DMEK）是有效的。角膜曲率计测量值保持不变，上皮厚度略有增加，术后角膜密度测量有所改善。
已知内容：DSO是一种针对富克斯营养不良等内皮性营养不良的无供体手术选择，在特定患者中利用眼睛的天然内皮再生能力。手术成功依赖于残余内皮细胞密度和术前角膜厚度等生物标志物来预测再生结果。
角膜小滴分布模式影响DSO的恢复时间线：B型（0°至180°子午线型）角膜小滴分布的患者比A型（中央角膜小滴）患者更快达到0.1 logMAR的CDVA，尽管在12个月时最终视力、角膜厚度测量和内皮细胞密度相似。DSO作为富克斯内皮性角膜营养不良的有效治疗方法：仅行后弹力层剥除术在大多数情况下3至4个月内可实现角膜清除，显著改善CDVA和生活质量（NEI VFQ - 25评分），支持其作为供体移植手术的微创替代方法的作用。
