Moayed Fuad, Steindor Friedrich Anton, Armeni Zaira Eleni, Kohlhaas Markus, Geerling Gerd
Department of Ophthalmology, Medical Faculty, University Hospital Düsseldorf, Moorenstraße 5, Düsseldorf 40225, Germany.
Department of Ophthalmology, University Hospital Düsseldorf, Düsseldorf, Germany.
Ther Adv Ophthalmol. 2025 Aug 30;17:25158414251359583. doi: 10.1177/25158414251359583. eCollection 2025 Jan-Dec.
In recent years, descemet stripping only (DSO) has emerged as an alternative to descemet membrane endothelial keratoplasty (DMEK) in certain patients with Fuchs endothelial dystrophy (FED). We herein report the 10-year follow-up of a 77-year-old male patient after bilateral DSO. The patient initially underwent DSO on the right eye for circumscribed cornea guttata. Three weeks after DSO, the best-corrected visual acuity (BCVA) already increased from 0.5 logarithm of the Minimum Angle of Resolution (logMAR) [Endothelial Cell Density (ECD) 1667/mm, Central Corneal Thickness (CCT) 583 µm] to 0.2 logMAR, and further improved to 0 logMAR 1 year after surgery (ECD 2213/mm, CCT 567 µm). This excellent visual acuity remained stable over the following 5 years (ECD 1696/mm, CCT 568 µm). Five years after the successful surgery on the right eye, DSO was also performed on the left eye by the same surgeon as FED progressed, with BCVA dropping to 0.5 logMAR (ECD unmeasurable, CCT 703 µm). However, this time, the treatment did not improve vision. Consequently, a DMEK was performed 7 months after DSO, which increased the BCVA to 0.1 logMAR. Ten years after successful DSO of the right eye, corneal guttata were observed, indicating de novo formation of a descemet membrane, and vision deteriorated again to 0.2 logMAR (ECD not measurable, CCT 641 µm). DMEK was also performed on the right eye ten years after successful DSO, which improved vision to 0.2 logMAR at one-year follow-up. This case suggests that DSO may be a temporary alternative to DMEK in FED, potentially providing excellent visual gain and good central endothelial cell density for nearly ten years. However, it may still fail due to long-term progression of the disease. It also highlights that the outcome may be limited by individual factors. Therefore, it is crucial to educate the patient about the limitations of DSO, both in short and long term. Nevertheless, if DSO fails, endothelial keratoplasty can still be successfully performed.
近年来，单纯后弹力层剥除术（DSO）已成为某些患有Fuchs内皮营养不良（FED）患者的Descemet膜内皮角膜移植术（DMEK）的替代方法。我们在此报告了一名77岁男性患者双侧DSO术后10年的随访情况。该患者最初因局限性角膜滴状病变接受了右眼的DSO手术。DSO术后三周，最佳矫正视力（BCVA）已从0.5最小分辨角对数（logMAR）[内皮细胞密度（ECD）1667/mm，中央角膜厚度（CCT）583μm]提高到0.2 logMAR，并在术后1年进一步提高到0 logMAR（ECD 2213/mm，CCT 567μm）。在接下来的5年中，这种出色的视力保持稳定（ECD 1696/mm，CCT 568μm）。右眼成功手术后5年，由于FED进展，同一位外科医生对左眼也进行了DSO手术，BCVA降至0.5 logMAR（ECD无法测量，CCT 703μm）。然而，这次治疗并未改善视力。因此，在DSO术后7个月进行了DMEK手术，使BCVA提高到0.1 logMAR。右眼成功进行DSO手术10年后，观察到角膜滴状病变，表明后弹力层重新形成，视力再次恶化至0.2 logMAR（ECD无法测量，CCT 641μm）。右眼成功进行DSO手术10年后也进行了DMEK手术，在1年随访时视力提高到0.2 logMAR。该病例表明，DSO可能是FED患者DMEK的一种临时替代方法，可能在近十年内提供出色的视力改善和良好的中央内皮细胞密度。然而，由于疾病的长期进展，它仍可能失败。这也突出表明，结果可能受到个体因素的限制。因此，至关重要的是要告知患者DSO在短期和长期内的局限性。尽管如此，如果DSO失败，内皮角膜移植术仍可成功进行。
