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Abstract：
BACKGROUND: This study aims to evaluate visual outcome, central corneal thickness, and re-bubbling rate in a cohort with undersized sequential Descemet Membrane Endothelial Keratoplasty (DMEK) due to endothelial graft decompensation following primary penetrating keratoplasty (PK).
METHODS: All patients who received a sequential DMEK (n = 16) or triple DMEK (n = 2) after failed primary PK between November 2020 and June 2022 were retrospectively evaluated. Analyzed parameters were corrected distance visual acuity (CDVA), central corneal thickness (CCT), re-bubbling rate and graft survival.
RESULTS: 18 eyes of 18 patients were included. All patients underwent a DMEK with undersized graft after failed PK(s). Mean time between the last PK and DMEK was 102 ± 82 weeks. Mean follow-up time was 8.9 ± 4.6 months. CDVA increased significantly from 1.12 ± 0.60 logMAR preoperatively to 0.64 ± 0.49 logMAR 6 weeks postoperatively (p = 0.013). Mean CCT decreased significantly from 807 ± 224 μm before to 573 ± 151 μm 6 weeks after DMEK (p = 0.003). Re-bubbling was necessary in eight eyes (44.4%) after a median time of 7 days. The 12-month Kaplan Meier survival was 66.7%.
CONCLUSIONS: In case of endothelial graft decompensation without stromal scars after primary PK, a DMEK can be performed for selected patients who had satisfying CDVA before the endothelial decompensation. Prior to DMEK indication, an AS-OCT should routinely be performed to circularly search for posterior steps at the PK graft margin, as well as shortly after DMEK to exclude a detachment of the endothelial graft. All patients should be informed about a higher re-bubbling rate in comparison to primary DMEK.
METHODS: All patients who received a sequential DMEK (n = 16) or triple DMEK (n = 2) after failed primary PK between November 2020 and June 2022 were retrospectively evaluated. Analyzed parameters were corrected distance visual acuity (CDVA), central corneal thickness (CCT), re-bubbling rate and graft survival.
RESULTS: 18 eyes of 18 patients were included. All patients underwent a DMEK with undersized graft after failed PK(s). Mean time between the last PK and DMEK was 102 ± 82 weeks. Mean follow-up time was 8.9 ± 4.6 months. CDVA increased significantly from 1.12 ± 0.60 logMAR preoperatively to 0.64 ± 0.49 logMAR 6 weeks postoperatively (p = 0.013). Mean CCT decreased significantly from 807 ± 224 μm before to 573 ± 151 μm 6 weeks after DMEK (p = 0.003). Re-bubbling was necessary in eight eyes (44.4%) after a median time of 7 days. The 12-month Kaplan Meier survival was 66.7%.
CONCLUSIONS: In case of endothelial graft decompensation without stromal scars after primary PK, a DMEK can be performed for selected patients who had satisfying CDVA before the endothelial decompensation. Prior to DMEK indication, an AS-OCT should routinely be performed to circularly search for posterior steps at the PK graft margin, as well as shortly after DMEK to exclude a detachment of the endothelial graft. All patients should be informed about a higher re-bubbling rate in comparison to primary DMEK.
摘要：
背景：这项研究旨在评估视觉结果，中央角膜厚度,由于初次穿透性角膜移植术（PK）后内皮移植物失代偿，导致尺寸过小的连续Descemet膜内皮角膜移植术（DMEK）的队列中的再起泡率。
方法：对所有在2020年11月至2022年6月原发性PK失败后接受序贯DMEK（n=16）或三重DMEK（n=2）的患者进行回顾性评估。分析参数为校正远距视力（CDVA），中央角膜厚度(CCT),再起泡率和移植物存活率。
结果：纳入18例患者的18只眼。所有患者在失败的PK(s)后接受了带有过小移植物的DMEK。最后一次PK和DMEK之间的平均时间为102±82周。平均随访时间为8.9±4.6个月。CDVA从术前的1.12±0.60logMAR显著增加至术后6周的0.64±0.49logMAR(p=0.013)。平均CCT从DMEK前的807±224μm显著降低至DMEK后6周的573±151μm(p=0.003)。在7天的中位时间后，八只眼睛（44.4％）需要重新起泡。12个月KaplanMeier生存率为66.7%。
结论：在原发性PK后无基质瘢痕的内皮移植物失代偿的情况下，可以对在内皮失代偿之前CDVA满意的部分患者进行DMEK。在DMEK指示之前,应常规进行AS-OCT以循环搜索PK移植物边缘的后台阶，以及在DMEK后不久排除内皮移植物的脱离。与原发性DMEK相比，应告知所有患者更高的再起泡率。
方法：对所有在2020年11月至2022年6月原发性PK失败后接受序贯DMEK（n=16）或三重DMEK（n=2）的患者进行回顾性评估。分析参数为校正远距视力（CDVA），中央角膜厚度(CCT),再起泡率和移植物存活率。
结果：纳入18例患者的18只眼。所有患者在失败的PK(s)后接受了带有过小移植物的DMEK。最后一次PK和DMEK之间的平均时间为102±82周。平均随访时间为8.9±4.6个月。CDVA从术前的1.12±0.60logMAR显著增加至术后6周的0.64±0.49logMAR(p=0.013)。平均CCT从DMEK前的807±224μm显著降低至DMEK后6周的573±151μm(p=0.003)。在7天的中位时间后，八只眼睛（44.4％）需要重新起泡。12个月KaplanMeier生存率为66.7%。
结论：在原发性PK后无基质瘢痕的内皮移植物失代偿的情况下，可以对在内皮失代偿之前CDVA满意的部分患者进行DMEK。在DMEK指示之前,应常规进行AS-OCT以循环搜索PK移植物边缘的后台阶，以及在DMEK后不久排除内皮移植物的脱离。与原发性DMEK相比，应告知所有患者更高的再起泡率。
