目的:确定早期中央角膜厚度(CCT)和最佳矫正视力(BCVA)的变化是否表明无并发症的Descemet膜内皮角膜移植术(DMEK)后移植物脱离。
方法:在对我们前瞻性收集的ADDA注册数据的分析中(https://drks。去/搜索/去/试用/DRKS00027180),45只假晶状体眼在眼科接受了DMEK手术,亚琛工业大学。前段光学相干断层扫描(AS-OCT),角膜后表面存在基质波纹,和BCVA测量值在之前进行了评估,1天,1周,1个月,手术后6个月。
结果:眼睛分为三组:无移植物脱离(组1)(20/45;44.4%),<1/3移植物脱离(第2组)(14/45;31.1%),≥1/3移植物脱离后再起泡(第3组)(11/45;24.4%)。第3组的眼睛在(746.8±95.8µmvs.665.0±74.4µm,P=0.041),和1周(666.8±119.5µmvs.556.5±56.8µm,与第1组相比,DMEK后P=0.001)。到1个月,CCT在所有组对齐。比较DMEK之前和之后1周,第1组的眼睛没有CCT增加,而CCT在第2组的25.0%和第3组的22.2%中增加。在第1组中,90.0%的人在DMEK后1周的CCT<600µm,相比之下,第2组只有50.0%,第3组只有36.4%。在第1组中,在DMEK后1周,90.0%(18/20)的BCVA有所改善,而在第2组和第3组中,86.7%(12/14)和18.2%(2/11)改善,分别。第3组中的一名患者在DMEK后1天和1周出现后基质波纹。
结论:如果在无并发症的DMEK术后1周CCT<600µm,并且较术前有所下降,BCVA有所改善,并且没有后部基质波纹,移植物脱离≥1/3和需要再起泡的可能性很小。在所有其他情况下,应建议对周围移植物进行细致的裂隙灯和OCT检查,以进行脱离检查。
OBJECTIVE: To determine if early central corneal thickness (CCT) and best-corrected visual acuity (BCVA) changes indicate graft detachment after uncomplicated Descemet membrane endothelial keratoplasty (DMEK).
METHODS: In this analysis of our prospectively collected ADDA registry data ( https://drks.de/search/de/trial/DRKS00027180 ), 45 pseudophakic eyes underwent DMEK surgery at the Department of Ophthalmology, RWTH Aachen University. Anterior segment optical coherence tomography (AS-OCT), the presence of stromal ripples on the posterior corneal surface, and BCVA measurements were assessed prior to, 1 day, 1 week, 1 month, and 6 months after surgery.
RESULTS: Eyes were categorized into three groups: no graft detachment (group 1) (20/45; 44.4%), < 1/3 graft detachment (group 2) (14/45; 31.1%), ≥ 1/3 graft detachment followed by rebubbling (group 3) (11/45; 24.4%). Eyes in group 3 had a greater CCT prior to (746.8 ± 95.8 µm vs. 665.0 ± 74.4 µm, P = 0.041), and 1 week (666.8 ± 119.5 µm vs. 556.5 ± 56.8 µm, P = 0.001) after DMEK compared to group 1. By 1 month, CCT in all groups aligned. Comparing prior to and 1 week after DMEK, none of the eyes in group 1 had an increase in CCT, while the CCT increased in 25.0% of eyes in group 2 and 22.2% in group 3. In group 1, 90.0% had a CCT of < 600 µm 1 week after DMEK, compared to only 50.0% in group 2 and 36.4% in group 3. In group 1, 90.0% (18/20) had an improved BCVA 1 week after DMEK, while in groups 2 and 3, 86.7% (12/14) and 18.2% (2/11) improved, respectively. One patient in group 3 showed posterior stromal ripples 1 day and 1 week after DMEK.
CONCLUSIONS: If 1 week after uncomplicated DMEK CCT is < 600 µm and has decreased from before surgery, BCVA has improved, and there are no posterior stromal ripples, a graft detachment ≥ 1/3 and the need for rebubbling are very unlikely. In all other cases, meticulous slit-lamp and OCT inspection of the peripheral graft for detachments should be advised.