Treatment of Fuchs Endothelial Dystrophy by Descemet Stripping Without Endothelial Keratoplasty
Treatment of Fuchs Endothelial Dystrophy by Descemet Stripping Without Endothelial Keratoplasty
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DOI：
10.1097/ico.0000000000000915
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发表时间：
2016-10-01
期刊：
影响因子：
2.8
通讯作者：
Colby, Kathryn A.
中科院分区：
文献类型：
--
作者：
Borkar, Durga S.;Veldman, Peter;Colby, Kathryn A.
目的：评价故意去除中央后弹力膜对Fuchs内皮营养不良症(Fuchs elialdstrophy，FED)和白内障超声乳化术患者内皮功能和形态的影响。方法：在这个回顾性病例系列中，在马萨诸塞州波士顿的一个学术角膜实践中，Fuchs内皮营养不良症和白内障患者接受了超声乳化术。人工晶状体植入后剥离中央后弹力膜4毫米。分别于术前、术后1、3、6、12个月进行视力、角膜测厚和内皮解剖共聚焦成像。根据术后可见中央内皮细胞镶嵌的角膜水肿消退时间，将患者分为快反应组、反应组、慢反应组和无反应组。结果：11例(13眼)年龄51~91岁。术前共聚焦成像无一只眼有可计数的中央内皮细胞。术前视力20/25~20/400。术后第1天和第7天，所有角膜在后弹力层剥离区均可见基质和微囊性水肿。术后1个月有4只眼角膜水肿消退，中央内皮细胞镶嵌可见(410~864个/mm(2))，视力20/25~20/40。另外4只眼在术后3个月时表现出类似的反应，另外2只眼在术后6个月或更晚时角膜水肿消退，中央内皮细胞马赛克完整。在最后一次随访(范围：术后6-24个月)时，所有10名应答者的细胞计数(范围：428-864个/mm(2))均保持不变。除2只眼视网膜病变外，其余10只眼最终视力在20/15~20/20之间。3只眼需行角膜内皮成形术。结论：白内障摘除术后FED患者中央角膜内皮细胞可发生再充盈并伴有角膜消肿。这可能为FED患者提供一种新的治疗方法，从而减少内皮移植的需要。需要进一步的研究来描述Descemet剥离的最佳患者群体，因为并不是所有的患者都会对这种干预措施有反应。
Purpose:To evaluate the effect of deliberate removal of the central Descemet membrane on endothelial function and morphology in patients with Fuchs endothelial dystrophy (FED) and cataract undergoing phacoemulsification.Methods:In this retrospective case series, patients with FED and visually significant cataract underwent phacoemulsification in an academic cornea practice in Boston, MA. Four millimeters of the central Descemet membrane was stripped and removed after intraocular lens insertion. Vision, corneal pachymetry, and confocal imaging of the endothelial anatomy were performed before surgery and at 1, 3, 6, and 12 months after surgery. Patients were classified as fast responders, responders, slow responders, and nonresponders on the basis of postoperative time to resolution of corneal edema with visible central endothelial mosaic.Results:Eleven patients (13 eyes) aged 51 to 91 years were included in the study. No eyes had countable central endothelial cells by confocal imaging before surgery. Preoperative visual acuity ranged from 20/25 to 20/400. All corneas showed stromal and microcystic edema in the area of Descemet stripping at days 1 and 7 after surgery. Four eyes demonstrated resolution of corneal edema with visible central endothelial cell mosaic (range: 410-864 cells/mm(2)) by postoperative month 1 with visual acuity ranging between 20/25 and 20/40. Four additional eyes demonstrated a similar response by postoperative month 3 and an additional 2 eyes had resolution of corneal edema with an intact central endothelial mosaic at postoperative month 6 or later. Cell counts (range: 428-864 cells/mm(2)) were maintained in all 10 responders at the last follow-up visit (range: postoperative months 6-24). Final vision ranged from 20/15 to 20/20 in these 10 eyes with the exception of 2 eyes with retinal pathology. Three eyes required endothelial keratoplasty.Conclusions:Repopulation of the central corneal endothelium with corneal deturgescence can occur after deliberate central Descemet stripping in patients with FED who underwent cataract removal. This may offer a novel treatment for patients with FED that could reduce the need for endothelial transplantation. Further studies are needed to delineate the optimal patient population for Descemet stripping because not all patients will respond to this intervention.