Huang Minghai, Yin Guina, Hoang Thuthuy, Wu Zhifeng, Teng Jian, Liang Yanqing, Zhang Zhuoyuan, Wei Dongmei
Nanning Aier Eye Hospital, Nanning, China.
Front Med (Lausanne). 2025 May 20;12:1499422. doi: 10.3389/fmed.2025.1499422. eCollection 2025.
To compare the potential effectiveness and safety of non-Descemet stripping endothelial keratoplasty (nDSEK) and Descemet stripping endothelial keratoplasty (DSEK) in treating endothelial decompensation.
A retrospective comparative analysis was conducted on patients with endothelial decompensation who underwent either nDSEK or DSEK procedures between August 2017 and January 2024. Participants were observed for a minimum duration of 12 months. The study documented key variables like best corrected visual acuity (BCVA), endothelial cell density (ECD), endothelial cell loss (ECL), and any issues that occurred during the follow-up period.
A total of 85 eyes from 85patients (nDSEK = 40 eyes, DSEK = 45 eyes) were ultimately included in the study for analysis based on the inclusion and exclusion criteria. The mean BCVA (logMAR) showed significant improvement from the preoperative measurement of 1.66 ± 0.26 to 0.37 ± 0.11 in nDSEK eyes and from the preoperative 1.68 ± 0.24 to 0.36 ± 0.10 in DSEK eyes, respectively, at postoperative 12 months. However, there was no statistically significant difference in the improvement of BCVA between the nDSEK and DSEK eyes ( = 0.605). The mean donor ECD decreased from the preoperative 2,814 ± 85 cells/mm to 1,195 ± 216 cells/mm (ECL 57.5%) in nDSEK eyes and from the preoperative 2,889 ± 125 cells/mm to 1,266 ± 285 cells/mm (ECL 56.2%) in DSEK eyes, respectively, at postoperative 12 months, with no significant difference between the nDSEK and DSEK eyes ( = 0.192). The occurrence of various complications (e.g., graft dislocation, acute hypertension, primary graft failure, graft rejection) was comparable between nDSEK and DSEK eyes.
nDSEK eliminated the descemetorhexis step but yielded a comparable clinical outcome in effectiveness and safety compared to DSEK for treating endothelial decompensation.
比较非后弹力层剥除内皮角膜移植术（nDSEK）和后弹力层剥除内皮角膜移植术（DSEK）治疗内皮失代偿的潜在有效性和安全性。
对2017年8月至2024年1月期间接受nDSEK或DSEK手术的内皮失代偿患者进行回顾性比较分析。对参与者进行至少12个月的观察。该研究记录了关键变量，如最佳矫正视力（BCVA）、内皮细胞密度（ECD）、内皮细胞丢失（ECL）以及随访期间出现的任何问题。
根据纳入和排除标准，最终共有来自85例患者的85只眼（nDSEK组 = 40只眼，DSEK组 = 45只眼）纳入研究进行分析。术后12个月时，nDSEK组患眼的平均BCVA（logMAR）从术前测量值1.66±0.26显著改善至0.37±0.11，DSEK组患眼从术前的1.68±0.24改善至0.36±0.10。然而，nDSEK组和DSEK组患眼在BCVA改善方面无统计学显著差异（P = 0.605）。术后12个月时，nDSEK组患眼供体内皮细胞密度从术前的2814±85个细胞/mm²降至1195±216个细胞/mm²（内皮细胞丢失率57.5%），DSEK组患眼从术前的2889±125个细胞/mm²降至1266±285个细胞/mm²（内皮细胞丢失率56.2%），nDSEK组和DSEK组患眼之间无显著差异（P = 0.192）。nDSEK组和DSEK组患眼各种并发症（如植片脱位、急性高眼压、原发性植片失败、植片排斥）的发生率相当。
nDSEK省去了后弹力层撕除步骤，但在治疗内皮失代偿方面，与DSEK相比，在有效性和安全性方面产生了相当的临床结果。
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