Hammer Thomas, Viestenz Arne, Kesper Christiane, Viestenz Anja
Universitätsklinikum Halle, Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
Augenzentrum "Frohe Zukunft Halle (S.)", Dessauer Str. 194, 06118, Halle (Saale), Deutschland.
Ophthalmologie. 2025 Aug 29. doi: 10.1007/s00347-025-02310-x.
In recent years, the Descemet membrane endothelial keratoplasty (DMEK) has become the standard transplantation procedure for endothelial corneal diseases due to faster visual recovery and lower graft rejection rates compared to penetrating keratoplasty (pKPL). Endothelial corneal decompensation after pKPL is also a possible indication for DMEK. The question is which intraoperative and postoperative aspects need to be considered.
We retrospectively reviewed the DMEK surgeries performed in our clinic in 2020 and 2021 after pKPL (n = 10) regarding intraoperative and postoperative characteristics as well as functional and morphological results.
Of the 10 eyes analyzed a repeat pKPL could be avoided by DMEK in 7 cases. The initial situation of the eyes was very different with respect to corneal decompensation, the primary indications for pKPL and number of previous pKPLs. The rate of postoperative gas re-injections (re-bubblings) was 80%, in some cases requiring multiple gas injections. A 20% sulphur hexafluoride (SF6) gas-air mixture was used for gas endotamponade. The improvement in visual acuity was highly variable. Overall, visual acuity in the treated eyes increased by 5.1 ± 1.4 lines after DMEK in the pKPL eyes (p < 0.001, minimum 3 lines, maximum 7 lines; logMAR preoperative 1.48 ± 0.36 to logMAR postoperative 0.57 ± 0.28).
The use of DMEK for endothelial graft failure after pKPL is a possible minimally invasive procedure to avoid repeat pKPL. The postoperative follow-up requires significantly more re-bubblings due to the altered anatomical situation and geometry of the posterior corneal surface after pKPL and the resulting poorer adhesion of Descemet's lamella.
近年来，由于与穿透性角膜移植术（pKPL）相比，Descemet膜内皮角膜移植术（DMEK）视觉恢复更快且移植排斥率更低，已成为角膜内皮疾病的标准移植手术。pKPL术后角膜内皮失代偿也是DMEK的一个可能指征。问题在于需要考虑哪些术中及术后因素。
我们回顾性分析了2020年和2021年在我们诊所对pKPL术后行DMEK手术的病例（n = 10），分析其术中及术后特征以及功能和形态学结果。
在分析的10只眼中，7例通过DMEK避免了再次行pKPL。这些眼睛的初始情况在角膜失代偿、pKPL的主要指征以及既往pKPL次数方面差异很大。术后气体再次注射（再次注气）率为80%，在某些情况下需要多次气体注射。使用20%的六氟化硫（SF6）气体 - 空气混合物进行气体内填塞。视力改善情况差异很大。总体而言，pKPL术后行DMEK治疗的眼睛视力提高了5.1±1.4行（p < 0.001，最小3行，最大7行；术前logMAR为1.48±0.36，术后logMAR为0.57±0.28）。
对于pKPL术后内皮移植失败使用DMEK是一种可能的微创方法，可以避免再次行pKPL。由于pKPL术后角膜后表面解剖结构和几何形状改变以及Descemet板层粘附性较差，术后随访需要更多的再次注气。
