Preliminary clinical results of Descemet membrane endothelial keratoplasty
Preliminary clinical results of Descemet membrane endothelial keratoplasty
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DOI：
10.1016/j.ajo.2007.09.021
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发表时间：
2008-02-01
影响因子：
4.2
通讯作者：
Van der Wees, Jacqueline
中科院分区：
文献类型：
--
作者：
Melles, Gerrit R. J.;Ong, T. San;Van der Wees, Jacqueline
目的：描述通过 3.5 毫米携带自体角膜内皮的培养器官供体后弹力层 (DM) 选择性移植的初步临床结果。男性切口，暂定名为后弹力层内皮角膜移植术（DMEK）。设计：非随机临床研究。方法：对 10 名 Fuchs 内皮营养不良或人工晶状体大疱性角膜病患者进行 DMEK 治疗。制作3.5毫米透明角膜隧道切口，前房充满空气，并从后基质剥离DM。从器官培养的供体角巩膜边缘采集直径 9.0 毫米的 DM 卷，并将其插入受体前房。将供体组织轻轻展开，放置在后基质上，并通过将前房完全充满空气 30 分钟来固定。 结果：1 个月时，6 只眼睛的最佳矫正视力为 0.5 (20/40) 或更高，3 只眼睛达到 1.0 (20/20)。六个月时，内皮细胞密度平均为 2030 (+/- 373) 个细胞/mm(2) (n = 7)。三只眼睛在术后早期显示供体组织完全脱离，通过移除移植物和二次后弹力层剥离内皮角膜移植术进行处理。结论：DMEK 可能有潜力成为治疗角膜内皮疾病的最佳技术，因为它提供快速且几乎完全的视力康复。由于所需的供体组织可以从器官培养的角巩膜边缘制备，因此大多数角膜外科医生可以轻松进行该手术。
PURPOSE: To describe the preliminary clinical results of selective transplantation of organ cultured, donor Descemet membrane (DM) carrying autologous corneal endothelium through a 3.5,mm. incision, tentatively named Descemet membrane endothelial keratoplasty (DMEK), for the Man. agement of corneal endothelial disorders.DESIGN: Nonrandomized clinical study.METHODS: In 10 patients with Fuchs endothelial dystrophy or pseudophakic bullous keratopathy, DMEK was performed. A 3.5-mm clear corneal tunnel incision was made, the anterior chamber was filled with air, and DM was stripped off from the posterior stroma. A 9.0-mm diameter DM roll was harvested from an organ cultured donor corneo-scleral rim, and inserted into a recipient anterior chamber. The donor tissue was gently unfolded, positioned onto the posterior stroma, and secured by completely filling the anterior chamber with air for 30 minutes.RESULTS: At one month, six eyes had a best-corrected visual acuity of 0.5 (20/40) or better, and three eyes reached 1.0 (20/20). At six months, the endothelial cell density averaged 2030 (+/- 373) cells/mm(2) (n = 7). Three eyes showed a complete detachment of the donor tissue in the early postoperative course that was managed by removal of the transplant and a secondary Descemet stripping endothelial keratoplasty procedure.CONCLUSION: DMEK may have potential to become the most preferable technique to manage corneal endothelial disorders, because it provides quick-and nearly complete visual rehabilitation. Because the donor tissue required can be prepared from organ cultured corneoscleral rims, the procedure may be readily accessable to most corneal surgeons.