American journal of ophthalmology · 2020
Endothelial Cell Loss After Descemet's Membrane Endothelial Keratoplasty for Fuchs' Endothelial Dystrophy: DMEK Compared to Triple DMEK.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Shahnazaryan David, Hajjar Sese Aida, Hollick Emma J
Аннотация
PURPOSE: This study compared the outcomes after Descemet's membrane endothelial keratoplasty (DMEK) in pseudophakic patients with the outcomes after DMEK combined with cataract surgery (triple-DMEK) in patients with Fuchs' endothelial dystrophy (FED).
DESIGN: Retrospective, single-institution, interventional, consecutive case series.
METHODS: Outcomes of 114 DMEKs in patients with FED at a minimum of 1-year follow-up were reviewed. A total of 34 eyes (29 patients) were pseudophakic and underwent only DMEK (DMEK-only), and 80 eyes (56 patients) underwent triple-DMEK. Main outcome measurements included endothelial cell loss (ECL), best-corrected visual acuity (BCVA), central corneal thickness (CCT), and complications.
RESULTS: At 1 month, ECL was 25% (±16%) and 35% (±15%) in DMEK-only and triple-DMEK groups, respectively. At 1 year, ECL was 33% (±13%) and 41% (±16%) in DMEK-only and triple-DMEK groups, respectively. There was statistically significantly less ECL after DMEK-only than after triple-DMEK at both 1 month (95% confidence interval [CI]: 1.67-15.02; P = .016) and 1 year (95% CI: 1.06-14.07; P = .034). CCT was significantly lower after DMEK-only than after triple-DMEK at 1 month but not at 1 year. BCVA was excellent and similar in the 2 groups. There were no cases of graft failure. Graft rejection and rebubbling rates were similar in DMEK-only and triple-DMEK groups: rejection occured in 8.8% and 8.75% of cases respectively (P = .50), and rebubbling in 2.9% and 2.5% respectively (P = .44).
CONCLUSIONS: Both the DMEK-only and the triple-DMEK groups had low rebubbling rates and good visual outcomes, but the combined triple-DMEK procedure resulted in significantly greater loss of endothelial cells than DMEK-only surgery at both 1 month and 1 year.
DESIGN: Retrospective, single-institution, interventional, consecutive case series.
METHODS: Outcomes of 114 DMEKs in patients with FED at a minimum of 1-year follow-up were reviewed. A total of 34 eyes (29 patients) were pseudophakic and underwent only DMEK (DMEK-only), and 80 eyes (56 patients) underwent triple-DMEK. Main outcome measurements included endothelial cell loss (ECL), best-corrected visual acuity (BCVA), central corneal thickness (CCT), and complications.
RESULTS: At 1 month, ECL was 25% (±16%) and 35% (±15%) in DMEK-only and triple-DMEK groups, respectively. At 1 year, ECL was 33% (±13%) and 41% (±16%) in DMEK-only and triple-DMEK groups, respectively. There was statistically significantly less ECL after DMEK-only than after triple-DMEK at both 1 month (95% confidence interval [CI]: 1.67-15.02; P = .016) and 1 year (95% CI: 1.06-14.07; P = .034). CCT was significantly lower after DMEK-only than after triple-DMEK at 1 month but not at 1 year. BCVA was excellent and similar in the 2 groups. There were no cases of graft failure. Graft rejection and rebubbling rates were similar in DMEK-only and triple-DMEK groups: rejection occured in 8.8% and 8.75% of cases respectively (P = .50), and rebubbling in 2.9% and 2.5% respectively (P = .44).
CONCLUSIONS: Both the DMEK-only and the triple-DMEK groups had low rebubbling rates and good visual outcomes, but the combined triple-DMEK procedure resulted in significantly greater loss of endothelial cells than DMEK-only surgery at both 1 month and 1 year.
Предметные рубрики MeSH
AgedAged, 80 and overCell CountCorneaCorneal Endothelial Cell LossDescemet Stripping Endothelial KeratoplastyEndothelium, CornealFemaleFollow-Up StudiesFuchs' Endothelial DystrophyGraft SurvivalHumansLens Implantation, IntraocularMaleMiddle AgedPhacoemulsificationPostoperative ComplicationsRetrospective StudiesTreatment OutcomeVisual Acuity