Update on the Surgical Management of Fuchs Endothelial Corneal Dystrophy.
Update on the Surgical Management of Fuchs Endothelial Corneal Dystrophy.
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DOI：
10.1007/s40123-020-00293-3
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发表时间：
2020-12
影响因子：
3.3
通讯作者：
Colby KA
中科院分区：
文献类型：
--
作者：
Blitzer AL;Colby KA
在美国，Fuchs内皮性角膜营养不良（FECD）是最常见的后角膜营养不良，也是角膜移植的主要适应症。FECD进展缓慢，患者逐渐发生角膜内皮失代偿，最终导致内皮细胞无法维持角膜去充血。医疗管理包括局部高渗剂，以促进角膜脱水，但手术干预往往需要恢复角膜清晰度。在过去的二十年里，随着角膜移植技术的发展，FECD的手术治疗已经有了很大的发展，因为角膜移植技术允许更有选择性的角膜移植和只更换病变的角膜层。先前的手术处理包括穿透性角膜移植术（PK），术中存在与“开放天空”相关的重大风险，以及术后移植排斥、伤口裂开、术后散光和长期视力康复的风险。在过去的15年中，内皮角膜移植术（EK）已成为内皮疾病的首选治疗方法，显著降低了FECD手术治疗的相关风险。在这里，我们讨论了目前FECD的外科治疗，包括只引入Descemet剥离（DSO），并强调了未来的研究工作。
Fuchs endothelial corneal dystrophy (FECD) is the most common posterior corneal dystrophy and the leading indication for corneal transplantation in the United States. FECD is slowly progressive, and patients develop gradual corneal endothelial decompensation, eventually resulting in failure of the endothelium to maintain corneal deturgescence. Medical management consists of topical hyperosmotic agents to facilitate dehydration of the cornea, but surgical intervention is often required to regain corneal clarity. The surgical management of FECD has evolved over the past two decades as corneal transplantation techniques have allowed for more selective keratoplasty and replacement of only the diseased layers of the cornea. Prior surgical management consisted of penetrating keratoplasty (PK) that carried significant intraoperative risks associated with “open sky” as well as postoperative risks of graft rejection, wound dehiscence, postoperative astigmatism, and prolonged visual rehabilitation. In the past 15 years, endothelial keratoplasty (EK) has become the treatment of choice for endothelial disease, significantly reducing the risks associated with the surgical treatment of FECD. Here we discuss the current surgical management of FECD, including the introduction of Descemet stripping only (DSO), and highlight future investigative efforts.
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