Cystoid macular oedema following Descemet membrane endothelial keratoplasty
Cystoid macular oedema following Descemet membrane endothelial keratoplasty
复制标题
DOI：
10.1136/bjophthalmol-2014-305124
复制
发表时间：
2015-01-01
影响因子：
4.1
通讯作者：
Reinhard, Thomas
中科院分区：
文献类型：
--
作者：
Heinzelmann, Sonja;Maier, Philip;Reinhard, Thomas
目的探讨角膜后弹力层内皮移植术（Descemet membrane endothelial keratoplasty，DMEK）并发黄斑囊样水肿（cystoid macular oedema，CMO）的发生率及其危险因素。2011年5月至2013年6月期间，在弗赖堡的Albert Ludwigs大学眼科中心，52%为假晶状体（DMEK），48%接受了同时白内障手术（DMEK联合白内障手术（Triple-DMEK））。在（三重）DMEK后6周、3个月和6个月以及因视力受限或下降而进行的计划外访视中进行了光谱域光学相干断层扫描（SD-OCT）。审查了病史中限制视力的既存合并症。排除有黄斑水肿病史的患者。我们使用Kaplan-Meier方法估计CMO的发生率。采用考克斯回归分析和Pearson相关分析CMO的潜在危险因素。考克斯模型包括以下变量：患者年龄和眼轴长度、同时进行的白内障手术、再泡率、供体年龄和供体内皮细胞密度。结果随访结束时，所有患眼中有13%发生了单次CMO。6个月后，13.3%的三重DMEK后的眼睛和12.5%的DMEK后的眼睛显示CMO。CMO的发展与最佳眼镜矫正视力之间存在统计学显著相关性。长眼轴长度对CMO发育具有保护作用（HR=0.3; p=0.03）。在药物治疗下，所有患者的中央凹厚度均降低。CMO对远期视力无明显影响。结论CMO是晶状体眼和假晶状体眼DMEK术后常见的并发症。经过药物治疗预后良好。我们建议在DMEK后的前6个月内定期进行SD-OCT监测。
Background To determine the incidence and potential risk factors of cystoid macular oedema (CMO) following Descemet membrane endothelial keratoplasty (DMEK) with or without simultaneous cataract surgery.Methods In this study, 155 eyes of 88 patients suffering from Fuchs endothelial dystrophy (81%), bullous keratopathy (17.6%) or other corneal diseases (1.4%) underwent DMEK. 52% were pseudophacic (DMEK) and 48% received simultaneous cataract surgery (DMEK combined with cataract surgery (Triple-DMEK)) at the Eye Center at Albert Ludwigs University of Freiburg between May 2011 and June 2013. Spectral-domain optical coherence tomography (SD-OCT) was performed 6 weeks, 3 months and 6 months following (Triple-) DMEK and in unscheduled visits due to limited or decreased visual acuity. The medical records were reviewed for pre-existing comorbidities limiting visual acuity. Patients with a history of macular oedema were excluded. We estimated the incidence of CMO using the Kaplan-Meier method. Potential risk factors for CMO were analysed with a Cox regression analysis and Pearson's correlation. The Cox model included the following variables: patient age and axial length, simultaneous cataract surgery, rate of rebubbling, donor age and donor endothelial cell density.Results 13% of all eyes developed a single episode of CMO at the end of the follow-up. After 6 months, 13.3% of eyes following Triple-DMEK and 12.5% of eyes following DMEK showed CMO. There was a statistically significant correlation between CMO development and best spectacle corrected visual acuity. Long axial length had a protective effect on CMO development (HR=0.3; p=0.03). Under medical therapy, central foveal thickness decreased in all patients. CMO did not have a relevant effect on long-term visual acuity.Conclusions CMO is a frequent complication following DMEK in phacic and pseudophacic eyes. The prognosis is excellent given medical treatment. We recommend regular SD-OCT monitoring during the first 6 months following DMEK.