内皮角膜移植术配合整个受术者的 Descemet 剥脱术治疗虹膜角膜内皮综合征的临床效果。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2024-09-27 DOI:10.1016/j.ajo.2024.09.024

Xiaojuan Dong , Chen Ouyang , Qinying Ye , Jing Wu , Chenjia Xu , Lingling Fu , Minglu Ma , Jiayin Peng , Ting Huang

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引用次数: 0

摘要

目的：研究针对虹膜角膜内皮（ICE）综合征的 Descemet 膜内皮角膜移植术（DMEK）后，整个受术者的 Descemet 剥离是否会减少内皮细胞丢失（ECL）：中山眼科中心患者： 48名患者（48只眼睛）：2014年3月10日至2022年5月11日期间，48名ICE综合征患者（48眼）入组。符合条件的患者被分为整个受体的Descemet剥离组（整个剥离组，24眼）或标准技术组（标准组，24眼）：干预措施：所有病例均同时进行DMEK手术。干预措施：所有病例均同时进行DMEK手术，术中去除整个受术者的Descemet膜或直径为8.0或8.25毫米的中央Descemet膜：主要结果指标：比较术后9、12和24个月的ECL、矫正远视力（CDVA）、眼压（IOP）、移植物存活率和手术并发症：随访 9 个月后，整个剥离组的 ECL 明显低于标准组。术后 2 年，整个剥离组和标准组的 ECL 率分别为 66±5% 和 74±4%（95% 置信区间 (CI)：-0.04 至 0.01；P = 0.040），累计移植成功率分别为 83% 和 67%（95%CI：-0.07 至 0.39；P = 0.318）。在整个随访期间，两组的术后 CDVA 水平相当。两组的主要并发症发生率无明显差异：结论：整个受体的Descemet剥离可延缓ICE综合征的病理进展，从而减少DMEK术后的ECL。

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Clinical Outcomes of Endothelial Keratoplasty With a Recipient's Entire Descemet Stripping for Iridocorneal Endothelial Syndrome

Purpose

To investigate whether a recipient's entire Descemet stripping reduced endothelial cell loss (ECL) after Descemet membrane endothelial keratoplasty (DMEK) for iridocorneal endothelial (ICE) syndrome.

Design

Randomized controlled clinical trial.

Methods

A total of 48 patients (48 eyes) with ICE syndrome were enrolled between 10 March 2014 and 11 May 11 2022. The eligible patients were divided into the entire recipient's Descemet stripping group (entire stripping group, 24 eyes) or the standard technique group (standard group, 24 eyes). DMEK was performed in all cases with concomitant procedures. The recipient's entire Descemet membrane or the central 8.0- or 8.25-mm diameter of the Descemet membrane was removed intraoperatively. Main outcome measures were ECL, corrected distance visual acuity (CDVA), intraocular pressure (IOP), graft survival, and surgical complications, which were compared 9, 12, and 24 months after surgery.

Results

After a 9-month follow-up, ECL was significantly lower in the entire stripping group than in the standard group. At 2 years postoperatively, the ECL rate was 66% ± 5% and 74% ± 4% (95% CI: −0.04 to 0.01; P = .040), with a cumulative graft success rate of 83% and 67% (95% CI: −0.07 to 0.39; P = .318) in the entire stripping group and the standard group, respectively. The postoperative CDVA level was comparable between the 2 groups throughout the follow-up period. No significant differences between the 2 groups were observed in regard to the incidence of main complications.

Conclusions

Entire recipient's Descemet stripping may delay the pathological progression of ICE syndrome, thereby reducing ECL after DMEK.

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.