Descemetorhexis Without Grafting for Fuchs Endothelial Dystrophy-Supplementation With Topical Ripasudil
Descemetorhexis Without Grafting for Fuchs Endothelial Dystrophy-Supplementation With Topical Ripasudil
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DOI：
10.1097/ico.0000000000001209
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发表时间：
2017-06-01
期刊：
影响因子：
2.8
通讯作者：
Devasahayam, Raj N.
中科院分区：
文献类型：
--
作者：
Moloney, Gregory;Petsoglou, Constantinos;Devasahayam, Raj N.
目的：报道不移植的去骨切术作为治疗Fuchs营养不良的主要干预措施的安全性和有效性，以及在失败病例中使用ROCK抑制剂利帕舒地尔作为补救剂。方法：11例患者12眼行不超过4mm的中枢性脱位。所有人都有富氏营养不良导致的视觉症状，需要干预。排除标准是外周内皮细胞计数，1000和中央水肿。每月记录角膜清除率和视觉参数，直到观察到角膜清除率，然后每隔6个月记录一次。2个月前未清除的病例将考虑进行救助处理。这包括用2种rho相关激酶抑制剂滴眼液中的1种进行治疗。对于不成功的病例，我们计划将内皮角膜移植术作为最后的抢救手术。结果：12只眼中有9只在2 ~ 6个月间自行清除。第5个月，1只眼睛没有清除，局部使用Y-27632，没有成功。行内皮角膜移植术。2只眼的愈合在3个月和2个月时停止。在这两种情况下，局部利帕舒地尔每天6次，连续2周导致完全的角膜清除。在达到角膜清除率的病例中，最佳眼镜矫正视力从平均0.26提高到0.125 (logMAR)，主观视觉质量得到改善。结论：Fuchs营养不良伴中枢性瘘管所致视力下降的患者，不植入术是一种可行的视力恢复方法。需要仔细选择患者，但局部利帕舒地尔作为挽救剂的出现表明手术的广泛应用是可能的。现在需要进一步研究这种药剂的用途。
Purpose: To report the safety and efficacy of descemetorhexis without grafting as a primary intervention in Fuchs dystrophy, and the use of a ROCK inhibitor, ripasudil as a salvage agent in failing cases.Methods: Twelve eyes of 11 patients underwent central descemetorhexis not exceeding 4 mm. All had Fuchs dystrophy-producing visual symptoms, requesting intervention. Exclusion criteria were a peripheral endothelial cell count,1000 and central edema. Corneal clearance and visual parameters were recorded monthly until corneal clearance was observed, then at intervals of 6 months. Cases failing to clear by month 2 were considered for salvage treatment. This consisted of treatment with 1 of 2 formulations of Rho-associated kinase inhibitor eye drops. Endothelial keratoplasty was planned as the final salvage procedure in unsuccessful cases.Results: Nine of 12 eyes cleared spontaneously between 2 and 6 months. One eye failed to clear by month 5 and topical Y-27632 was administered, without success. Endothelial keratoplasty was performed. In 2 eyes, healing stalled at 3 and 2 months. In both cases, topical ripasudil administered 6 times a day for 2 weeks resulted in complete corneal clearance. In cases achieving corneal clearance, best spectacle corrected visual acuity improved from a mean of 0.26 to 0.125 (logMAR) with subjective improvement in quality of vision.Conclusions: In Fuchs dystrophy with visual degradation due to central guttae, descemetorhexis without grafting is a viable procedure for visual rehabilitation. Careful patient selection is required, but the advent of topical ripasudil as a salvage agent suggests that a broader application of the surgery may be possible. Further study into the use of this agent is now needed.