Descemet's Membrane Endothelial Keratoplasty

Autor: Francis W. Price, Frederico P. Guerra, Arundhati Anshu, Marianne O. Price, Arthur W. Giebel
Rok vydání: 2011
Předmět:
Zdroj: Ophthalmology. 118:2368-2373
ISSN: 0161-6420
DOI: 10.1016/j.ophtha.2011.06.002
Popis: Purpose To report 1-year outcomes of Descemet's membrane endothelial keratoplasty (DMEK) performed at 2 centers. Design Prospective, consecutive, interventional series. Participants Patients with Fuchs' endothelial dystrophy, pseudophakic bullous keratoplasty, or failed previous graft (n = 136 eyes). Intervention The diseased central 7 mm of Descemet's membrane (DM) was stripped from the recipient cornea and replaced with healthy DM and endothelium stripped from donor corneas through a 2.8-mm corneal incision. Descemet's membrane endothelial keratoplasty was performed alone (n = 110) or combined with either phacoemulsification and intraocular lens implantation (n = 23) or pars plana vitrectomy (n = 3). Main Outcome Measures Best spectacle-corrected visual acuity (BSCVA), manifest refraction, and endothelial cell density. Results Excluding eyes with pre-existing ocular comorbidities or those lost to follow-up, mean BSCVA at 1 year was 0.07 logarithm minimum angle of resolution (logMAR) units (20/24; range, 20/15–20/40; n=81), improving from 0.51 logMAR (20/65; range, 20/20–counting fingers); 41% of the patients achieved a BSCVA of 20/20 or better, 80% could be corrected to 20/25 or better, and 98% achieved 20/30 or better vision. A refractive hyperopic shift of +0.24±1.01 diopters (D; range, –1.50 to 2.25 D) was found at 1 year, but it was not statistically significant ( P = 0.08). Also, there was no significant change in the preoperative astigmatism ( P = 0.17). The endothelial cell loss at 1 year was 36±20% (n = 94; range, 13%–88%), with most of the loss being observed during the first 3 months after surgery: 31±18% (range, 3%–77%). The DMEK graft creation could not be successfully completed in 6 cases (4.2%). All these unsuccessful attempts were among the initial 40 cases. Intracameral air was used to fix graft detachments, which usually were partial and peripheral, in 62% of the cases. Eleven grafts (8%) demonstrated primary failure and 1 eye (0.7%) had secondary failure resulting from endothelial rejection. Episodes of immunologic rejection were documented in 7 eyes (5.1%) during the first year of follow-up. Conclusions Descemet's membrane endothelial keratoplasty had better visual acuity results in the first year after surgery than typically reported for other endothelial keratoplasty techniques, such as Descemet's stripping automated endothelial keratoplasty, while having less refractive changes and similar endothelial cell counts but a higher rebubbling rate. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Databáze: OpenAIRE
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