Lower Corneal Haze and Aberrations in Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Automated Endothelial Keratoplasty in Fellow Eyes for Fuchs Endothelial Corneal Dystrophy.
Lower Corneal Haze and Aberrations in Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Automated Endothelial Keratoplasty in Fellow Eyes for Fuchs Endothelial Corneal Dystrophy.
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下角膜雾和discemet膜内皮角膜膜成形术中的畸变与descemet剥离自动内皮角膜成形术，同伴的眼睛，以使其对富克斯内皮角膜营养不良。
DOI：
10.1097/ico.0000000000002416
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发表时间：
2020-10
期刊：
影响因子：
2.8
通讯作者：
Mootha VV
中科院分区：
文献类型：
--
作者：
Waldrop WH;Gillings MJ;Robertson DM;Petroll WM;Mootha VV
研究Fuchs角膜内皮营养不良（FECD）患者的长期角膜变化，与后弹力层剥脱式自动角膜内皮移植术（DSAEK）相比，后弹力层角膜内皮移植术（DMEK）有助于上级术后视力结局。采用回顾性分析，我们评估了9例FECD患者，他们在一只眼睛接受DSAEK，在另一只眼睛接受DMEK。对患者进行TCF 4基因三重重复扩增的基因分型，并使用光学相干断层扫描、Scheimpflug成像和体内聚焦共聚焦显微镜（CMTF）成像。9名受试者中有8名进行了基因分型，发现所有受试者都携带三重重复扩增。DSAEK和DMEK后内皮角膜移植术和成像之间的平均时间分别为76 +/-22和37 +/-9个月。DMEK眼与DSAEK眼的平均最佳眼镜矫正视力（logMAR）分别为0.04 +/− 0.05和0.11 +/− 0.03（P= 0.02）。DMEK眼的后角膜高阶像差（HOA）低于DSAEK眼（分别为0.25 +/− 0.06和0.66 +/− 0.25，P= <0.01）。使用CMTF，我们发现持续性前基质混浊在左右眼之间相关（R = 0.73，P = <0.05），但DSAEK眼的总基质背向散射较高（P= <0.05）。由于基质组织的添加，DSAEK固有地导致与DMEK相比更高的总基质背散射（雾度）。与DSAEK相比，DMEK后较低的后角膜HOA和较低的总基质后向散射（haze）均有助于获得上级视力结果。
To investigate the long term corneal changes in patients with Fuchs’ endothelial corneal dystrophy (FECD) contributing to superior postoperative visual outcomes after Descemet membrane endothelial keratoplasty (DMEK) compared to Descemet stripping automated endothelial keratoplasty (DSAEK). Using retrospective analysis, we evaluated nine patients with FECD who underwent DSAEK in one eye and DMEK in the fellow eye. Patients were genotyped for the triplet repeat expansion in the TCF4 gene and imaged using optical coherence tomography, Scheimpflug imaging, and in vivo confocal microscopy through focusing (CMTF). Eight of nine subjects were genotyped and all were found to harbor the triplet repeat expansion. Average time between endothelial keratoplasty and imaging was 76 +/− 22 and 37 +/− 9 months after DSAEK and DMEK respectively. Mean best spectacle corrected visual acuity (logMAR) was 0.04 +/− 0.05 and 0.11 +/− 0.03 in the DMEK eyes versus DSAEK eyes (P= 0.02). Posterior corneal higher order aberrations (HOAs) were less in DMEK eyes compared to fellow DSAEK eyes (0.25 +/− 0.06 and 0.66 +/− 0.25 respectively, P= <0.01). Using CMTF, we found the persistent anterior stromal haze is correlated between right and left eyes (R = 0.73, P = <0.05) but total stromal backscattering was higher for DSAEK eyes (P= <0.05). DSAEK inherently results in higher total stromal backscattering (haze) compared to DMEK due to the addition of stromal tissue. Lower HOAs of posterior cornea and lower total stromal backscattering (haze) may both contribute to superior visual outcomes after DMEK compared to DSAEK.