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后弹力膜内皮角膜移植术:安全性和预后:美国眼科学会的一份报告

Deng, S.X., Lee, W.B., Hammersmith, K.M., et al.

期刊名称:Ophthalmology

卷期:2018年第125卷第2期

摘要

摘要:目的:回顾已发表的在角膜内皮功能障碍的外科治疗中,角膜后弹力层内皮角膜移植术(DMEK)的安全性和疗效的相关文献。

方法:一直在PubMedCochrane图书馆数据库进行相关文献检索,最近一次是在20175月。这些搜索仅限于英文摘要,共计发表了1085篇文章。小组审查了这些摘要,并确定了47个与安全性和疗效的评估有关。

结果: 角膜后弹力层内皮角膜移植(DMEK)手术后,平均最佳矫正视力(BCVA)20/2120/31,随访时间跨度为5.7 ~ 68个月。在6个月内其中37.6%85%的眼睛达到20/25或更好的平均最佳矫正视力(BCVA), 17%67%达到20/20或更好的平均最佳矫正视力(BCVA)。在6个月内平均内皮细胞(EC)损失为33%(范围,25%-47%)

球形当量的总变化为+0.43屈光度(D;范围,-1.17+1.2 D),最小诱导散光为+0.03 D(范围,-0.03+1.11 D)。最常见的并发症是需要空气注射的部分移植物剥离(平均值28.8%;范围:0.2% - 76%)。眼压升高是角膜后弹力层内皮角膜移植(DMEK)术后第二大常见并发症(范围,0%-22%),其次是原发性移植物衰竭(平均值1.7%;范围,0%-12.5%),二次移植失败(平均值,2.2%;范围,0%-6.3%)和免疫排斥(平均值,1.9%;范围内,0% -5.9%)。在最后的随访中,角膜后弹力层内皮角膜移植(DMEK)的整体移植物生存率从92%100%不等。在9个月的时间里Descemet剥离内皮角膜成形术 (DSEK)后的最佳矫正视力范围从20/3420/66DSEK术后最常见的并发症为移植物分离(平均值14%;范围,0%-82%),内皮排斥(平均值,10%;范围,0%-45%),主要移植物失败(平均值,5%;范围内,0% - -29%)6个月内平均内皮细胞(EC)损失为37%

结论:本文的证据支持角膜后弹力层内皮角膜移植术(DMEK)作为一种安全有效的治疗内皮细胞衰竭的方法。虽然两者具有相似的手术风险和平均内皮细胞(EC)损失,但与DSEK相比,DMEK在视觉恢复时间、视力疗效和排斥率方面似乎都优于DSEK,而且DMEK诱导屈光不正的情况也较少。DMEKDSEKDMEKDSEK术后的空气注入和重复角膜成形术的发生率相似。在DMEK的学习曲线之中DMEKDSEK的空气注射和重复角膜成形术的发生率相似。

PURPOSE:To review the published literature on the safety and outcomes of Descemet membrane endothelial keratoplasty (DMEK) for the surgical treatment of corneal endothelial dysfunction.METHODS:Literature searches were last conducted in the PubMed and the Cochrane Library databases most recently in May 2017. The searches, which were limited to English-language abstracts, yielded 1085 articles. The panel reviewed the abstracts, and 47 were determined to be relevant to this assessment.RESULTS:After DMEK surgery, the mean best-corrected visual acuity (BCVA) ranged from 20/21 to 20/31, with follow-up ranging from 5.7 to 68 months. At 6 months, 37.6% to 85% of eyes achieved BCVA of 20/25 or better and 17% to 67% achieved BCVA of 20/20 or better. Mean endothelial cell (EC) loss was 33% (range, 25%-47%) at 6 months. Overall change in spherical equivalent was +0.43 diopters (D; range, -1.17 to +1.2 D), with minimal induced astigmatism of +0.03 D (range, -0.03 to +1.11 D). The most common complication was partial graft detachment requiring air injection (mean, 28.8%; range, 0.2%-76%). Intraocular pressure elevation was the second most common complication (range, 0%-22%) after DMEK, followed by primary graft failure (mean, 1.7%; range, 0%-12.5%), secondary graft failure (mean, 2.2%; range, 0%-6.3%), and immune rejection (mean, 1.9%; range, 0%-5.9%). Overall graft survival rates after DMEK ranged from 92% to 100% at last follow-up. Best-corrected visual acuity after Descemet's stripping endothelial keratoplasty (DSEK) ranged from 20/34 to 20/66 at 9 months. The most common complications after DSEK were graft detachment (mean, 14%; range, 0%-82%), endothelial rejection (mean, 10%; range, 0%-45%), and primary graft failure (mean, 5%; range, 0%-29%). Mean EC loss after DSEK was 37% at 6 months.CONCLUSIONS:The evidence reviewed supports DMEK as a safe and effective treatment for endothelial failure. With respect to visual recovery time, visual outcomes, and rejection rates, DMEK seems to be superior to DSEK and to induce less refractive error with similar surgical risks and EC loss compared with DSEK. The rate of air injection and repeat keratoplasty were similar in DMEK and DSEK after the learning curve for DMEK.


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