Ten-Year Clinical Outcome of the First Patient Undergoing Descemet Membrane Endothelial Keratoplasty
Ten-Year Clinical Outcome of the First Patient Undergoing Descemet Membrane Endothelial Keratoplasty
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DOI：
10.1097/ico.0000000000001111
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发表时间：
2017-03-01
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：
Baydoun, Lamis;Mueller, Thomas;Melles, Gerrit R. J.
目的：描述全球首例接受后弹力层角膜内皮移植术（DMEK）的患者的10年临床结局：方法：2006年，一名63岁的男性在鹿特丹的梅勒斯角膜诊所就诊，患有双侧Fuchs内皮营养不良和白内障。超声乳化后，在左眼和10个月后在右眼进行体内DMEK。在10年的时间里，每6个月记录一次最佳矫正视力（BSCVA）、内皮细胞密度、角膜厚度和并发症。左眼的BSCVA从术前的20/60（0.3）改善至1个月时的20/17（1.2），并在10年内保持稳定，范围为20/20（1.0）至20/13（1.5）。右眼的BSCVA从术前的20/50（0.4）和1个月时的20/60（0.3）改善至3个月时的20/25（0.8）和6个月时的20/17（1.2），9年内的范围为20/25（0.8）至20/17（1.2）。双眼分别在DMEK术后5年和4年接受YAG激光晶状体囊切开术治疗后囊膜混浊。右眼和左眼的内皮细胞密度在1年时分别下降了43%和45%，在5年时分别下降了52%和59%，在10/9年时分别下降了72%和68%。没有术中或术后并发症发生，在最后一次随访，双方的角膜是clear.Conclusions：世界上第一DMEK患者可能会显示这种内皮角膜移植技术的所有短期和长期的特点：突出的患者满意度，视力恢复快，并发症的发生率低，移植物寿命长。过去十年发表的研究表明，该病例是角膜移植新时代的开始。
Purpose: To describe the 10-year clinical outcome of the first patient worldwide who underwent Descemet membrane endothelial keratoplasty (DMEK).Methods: In 2006, a 63-year-old man presented at the Melles Cornea Clinic, Rotterdam, with bilateral Fuchs endothelial dystrophy and cataract. After phacoemulsification, in vivo DMEK was performed in the left eye and 10 months later in the right eye. Best spectacle-corrected visual acuity (BSCVA), endothelial cell density, pachymetry, and complications were recorded every 6 months over a 10-year period.Results: BSCVA in the left eye improved from 20/60 (0.3) before surgery to 20/17 (1.2) at 1 month, and remained stable over 10 years, ranging from 20/20 (1.0) to 20/13 (1.5). BSCVA in the right eye improved from 20/50 (0.4) preoperative and 20/60 (0.3) at 1 month to 20/25 (0.8) at 3 months and 20/17 (1.2) at 6 months, ranging from 20/25 (0.8) to 20/17 (1.2) over 9 years. Both eyes underwent YAG-laser-capsulotomy to manage posterior capsule opacification at 5 and 4 years after DMEK, respectively. Endothelial cell density in the right and left eyes, respectively, decreased by 43% and 45% at 1 year, 52% and 59% at 5 years, and 72% and 68% at 10/9 years, respectively. No intraoperative or postoperative complications occurred; at the last follow-up, both corneas were clear.Conclusions: The first DMEK patient worldwide may show all short and long-term characteristics of this endothelial keratoplasty technique: outstanding patient satisfaction, quick visual recovery, low incidence of complications, and graft longevity. Published studies in the past decade would suggest that this case was the start of a new era in corneal transplantation.