Incidence of Early Allograft Rejection After Descemet Membrane Endothelial Keratoplasty
Incidence of Early Allograft Rejection After Descemet Membrane Endothelial Keratoplasty
复制标题
DOI：
10.1097/ico.0b013e31820d8540
复制
发表时间：
2011-12-01
期刊：
影响因子：
2.8
通讯作者：
Melles, Gerrit R. J.
中科院分区：
文献类型：
--
作者：
Dapena, Isabel;Ham, Lisanne;Melles, Gerrit R. J.
目的：报告后弹力层内皮角膜移植术（DMEK）（即分离的后弹力层及其内皮移植）后早期同种异体移植排斥的发生率。方法：第一批 105 名患者的 120 只眼睛因 Fuchs 内皮营养不良或人工晶状体性大疱性角膜病接受手术，平均随访 2 年，随访时间为 9.0-200 年。直径为 10.0 毫米的 DMEK，参加了我们的研究。结果：在整个研究期间，只有一只眼睛表现出对后弹力层移植物产生细胞免疫反应的任何迹象。一名 76 岁患者在 DMEK（偏心）后 4 个月出现不适、数手指视力下降、角膜代偿失调以及中央角膜出现 Khodadoust 线。强化局部皮质激素治疗使视力在几周内完全恢复至 20/25 (0.8)。结论：DMEK 后可能会发生“经典”同种异体移植排斥反应（外观与穿透性角膜移植术后相似）。然而，与早期（内皮）角膜移植手术相比，DMEK 可能与较低的排斥率相关。
Purpose: To report the incidence of early allograft rejection after Descemet membrane endothelial keratoplasty (DMEK), that is, transplantation of isolated Descemet membrane with its endothelium.Methods: The first series of 120 eyes of 105 patients operated on for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy, with an average 2 years of follow-up after 9.0- to 10.0-mm-diameter DMEK, enrolled in our study.Results: During the entire study period, only 1 of the eyes showed any signs of a cellular immune response to the Descemet graft. A 76-year-old patient presented with discomfort, reduced visual acuity to counting fingers, corneal decompensation, and a Khodadoust line in the central cornea 4 months after (decentered) DMEK. Intensified topical corticoid therapy resulted in a complete visual recovery to 20/25 (0.8) within weeks.Conclusions: A "classic" allograft rejection (with an appearance similar to that after penetrating keratoplasty) can occur after DMEK. However, compared with the earlier (endothelial) keratoplasty procedures, DMEK may be associated with a lower rejection rate of