Multicenter Study of Descemet Membrane Endothelial Keratoplasty First Case Series of 18 Surgeons
Multicenter Study of Descemet Membrane Endothelial Keratoplasty First Case Series of 18 Surgeons
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DOI：
10.1001/jamaophthalmol.2014.1710
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发表时间：
2014-10-01
影响因子：
8.1
通讯作者：
Melles, Gerrit R. J.
中科院分区：
文献类型：
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作者：
Monnereau, Claire;Quilendrino, Ruth;Melles, Gerrit R. J.
重要外科医生开始进行Descemet膜内皮移植(DMEK)的学习曲线和其他人的经验应该被告知。目的在有经验的外科医生的学习曲线中记录标准化的“非接触式”DMEK的临床结果及其并发症。设计、设置和参与者的多中心回顾性研究。对401例(431只眼)Fuchs内皮营养不良(68.2%)和大泡性角膜病变(31.8%)患者进行了DMEK，手术由11个国家的18名医生完成。BCVA>20/40者217眼(78.9%)，>20/25者117眼(42.5%)，>20/20者61眼(22.2%)。随访至少6个月的眼(n=176)获得类似的BCVA结果。术后6个月内皮细胞密度平均下降47%(20%)(n=133，P=0.02)。术中并发症很少见，包括移植物难以插入、展开或定位(1.2%)和术中出血(0.5%)。术后主要并发症为植片脱离(34.6%)，20.4%接受一次再鼓泡手术，偶尔需要第二次(2.6%)和第三次再次鼓泡(0.7%)，17.6%接受第二次角膜移植。开始进行手术的外科医生面临的主要挑战可能是(1)决定移植准备是外包还是在手术中进行，(2)限制移植物分离和二次手术的数量，以及(3)获取器官培养的供体角膜组织。
IMPORTANCE Surgeons starting to perform Descemet membrane endothelial keratoplasty (DMEK) should be informed about the learning curve and experience of others.OBJECTIVE To document the clinical outcome of standardized "no-touch" DMEK and its complications during the learning curves of experienced surgeons.DESIGN, SETTING, AND PARTICIPANTS Retrospective multicenter study. A total of 431 eyes from 401 patients with Fuchs endothelial dystrophy (68.2%) and bullous keratopathy (31.8%) underwent DMEK performed by 18 surgeons in 11 countries.EXPOSURES Descemet membrane endothelial keratoplasty.MAIN OUTCOMES AND MEASURES Best-corrected visual acuity (BCVA), endothelial cell density, and intraoperative and postoperative complications.RESULTS Of 275 eyes available for BCVA pooled analysis, BCVA improved in 258 eyes (93.8%), remained unchanged in 12 (4.4%), and deteriorated in 5 (1.8%). Two hundred seventeen eyes (78.9%) reached a BCVA of at least 20/40 (>= 0.5), 117 (42.5%) at least 20/25 (>= 0.8), and 61 (22.2%) at least 20/20 (>= 1.0). Eyes with at least 6 months of follow-up (n = 176) reached similar BCVA outcomes. Mean (SD) decrease in endothelial cell density at 6 months was 47%(20%) (n = 133 [P = .02]). Intraoperative complications were rare, including difficulties in inserting, unfolding, or positioning of the graft (1.2%) and intraoperative hemorrhage (0.5%). The main postoperative complication was graft detachment (34.6%); 20.4% underwent a single rebubbling procedure, occasionally requiring a second (2.6%) and a third rebubbling (0.7%), and 17.6% underwent a second keratoplasty.CONCLUSIONS AND RELEVANCE Our multicenter study showed that the standardized no-touch DMEK technique was feasible in most hands. The main challenges for surgeons starting to perform the procedure may be (1) to decide whether graft preparation is outsourced or performed during surgery, (2) to limit the number of graft detachments and secondary procedures, and (3) to obtain organ cultured donor corneal tissue.