Hammer Thomas, Wieland P, Horn J, Viestenz A, Viestenz A
Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
Augenzentrum "Frohe Zukunft", Halle (Saale), Deutschland.
Ophthalmologie. 2025 May 13. doi: 10.1007/s00347-025-02238-2.
Descemet membrane endothelial keratoplasty (DMEK) is the gold standard for the treatment of endothelial corneal decompensation. The rapid postoperative improvement in visual acuity and the lower rejection rate of this minimally invasive procedure compared to penetrating keratoplasty justify the high acceptance of DMEK.
The aim of this study was to analyse the general conditions for an optimal visual outcome after DMEK by recording patient- and graft-dependent factors.
A total of 72 eyes were retrospectively analysed in which Fuchs' endothelial dystrophy was treated by DMEK at the University Eye Hospital in Halle in 2019 and 2020. The data at the following timepoints were collected: preoperative graft examination, examination prior to surgery and one examination within the first 6 months postoperatively and one in the second postoperative year. In particular, the best corrected visual acuity (BCVA) and endothelial cell density were compared. A patient survey was used to evaluate the subjectively perceived success of the therapy. The main focus was on reduction in symptoms and the regained independence and participation in social life.
The BCVA increased from 0.37 ± 0.15 (logMAR 0.43 ± 0.82) preoperatively to 0.65 ± 0.18 (logMAR 0.19 ± 0.74) in the second postoperative year. The endothelial cell density of the transplant decreased from 2503 ± 206 cells/mm preoperatively to 1441 ± 516 cells/mm in the second postoperative year and thus decreased on average by 42%. The corneal thickness decreased from 599 ± 58 µm preoperatively to 521 ± 48 µm in the second postoperative year and decreased on average by 78 ± 71 µm. More than 70% of the patients surveyed complained of sensitivity to light (n = 66), blurred vision (n = 64) and reduced colour perception (n = 59). 57% (n = 50) reported symptoms of glare. 50% of patients (n = 50) felt that their vision was better at the time of the survey than preoperatively and 40% (n = 40) felt that it was optimal. Of those surveyed 84% (n = 84) described their quality of life postoperatively as better or even optimal.
DMEK is an effective and safe procedure. The visual outcome can be influenced by various patient- and graft-dependent factors. Patients who had previously undergone other eye operations or had other eye diseases achieved a lower average postoperative increase in visual acuity. In addition, a correlation between donor gender and the decrease in endothelial cell density can be recognised. The endothelial cell loss in female donors is greater than in male donors.
Descemet膜内皮角膜移植术（DMEK）是治疗角膜内皮失代偿的金标准。与穿透性角膜移植术相比，该微创手术术后视力恢复快且排斥率低，这使得DMEK被广泛接受。
本研究旨在通过记录患者和移植物相关因素，分析DMEK术后获得最佳视力结果的一般条件。
回顾性分析了2019年和2020年在哈雷大学眼科医院接受DMEK治疗的72例Fuchs内皮营养不良患者的眼部情况。收集了以下时间点的数据：术前移植物检查、手术前检查、术后6个月内的一次检查以及术后第二年的一次检查。特别比较了最佳矫正视力（BCVA）和内皮细胞密度。通过患者调查评估治疗的主观成功率。主要关注症状的减轻以及恢复的独立性和参与社会生活的情况。
术后第二年，BCVA从术前的0.37±0.15（logMAR 0.43±0.82）提高到0.65±0.18（logMAR 0.19±0.74）。移植片的内皮细胞密度从术前的2503±206个/mm下降到术后第二年的1441±516个/mm，平均下降了42%。角膜厚度从术前的599±58µm下降到术后第二年的521±48µm，平均下降了78±71µm。超过70%的受调查患者抱怨有畏光（n=66）、视力模糊（n=64）和色觉减退（n=59）症状。57%（n=50）的患者报告有眩光症状。50%的患者（n=50）认为在调查时他们的视力比术前好，40%（n=40）的患者认为视力最佳。在受调查者中，84%（n=84）将他们术后的生活质量描述为更好甚至最佳。
DMEK是一种有效且安全的手术。视力结果可能受到多种患者和移植物相关因素的影响。先前接受过其他眼部手术或患有其他眼部疾病的患者术后视力平均提高幅度较低。此外，可以观察到供体性别与内皮细胞密度降低之间的相关性。女性供体内皮细胞损失大于男性供体。
