期刊
AMERICAN JOURNAL OF OPHTHALMOLOGY
卷 206, 期 -, 页码 94-101出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.ajo.2019.03.020
关键词
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资金
- Research to Prevent Blindness, New York City, New York
- National Eye Institute (Bethesda, Maryland) [RO1 EY021797, RO1 EY028557]
- California Institute for Regenerative Medicine (Oakland, California) [TR2 TR2-01768, CLIN1-08686]
- National Eye Institute, the Eye Bank Association of America (Washington, DC)
- Research to Prevent Blindness
- Aerie Pharmaceuticals (Durham, North Carolina)
- Allergan (Dublin, Ireland)
- Alcon (Elkridge, Maryland)
- New World Medical, Inc (Rancho Cucamonga, California)
- Glaukos Ltd (San Clemente, California)
- Unity Biotechnology (San Francisco, California)
- WL Gore and Associates (Newark, Delaware)
PURPOSE: To compare the outcomes of Descemet membrane endothelial keratoplasty (DMEK) with those of Descemet's stripping endothelial keratoplasty (DSEK) in eyes with prior glaucoma surgery. DESIGN: Case-matched retrospective comparative case series. METHODS: Setting/study population: 46 DMEK procedures were matched with 46 DSEK procedures at a single institution. Observation procedures: cases were matched based on preoperative visual acuity, lens status, and surgical indication. Main outcome measurements: the outcome measurements included visual acuity improvement, primary and secondary graft failure, endothelial rejection, intraocular pressure (IOP) elevation, and the need for additional glaucoma intervention. RESULTS: Best-corrected visual acuity (BCVA) improved by - 0.89 logMAR in the DMEK group and -0.62 logMAR in the DSEK group (P = 0.005) at 1 year follow-up. Visual acuity was significantly better in the DMEK group at postoperative months 1, 3, and 12 and at last follow-up. The percentage of patients achieving 20/40 or better best-corrected visual acuity was higher in the DMEK group at all time points, notably 47% in the DMEK group versus 15% in the DSEK group at 1 year (P = 0.002). Secondary graft failure was lower in the DMEK group (DMEK 0% vs. DSEK 17%; P = 0.006). Primary graft failure rates and rebubling rates were similar. There were no differences in the rates of postoperative IOP elevation or in the need for additional glaucoma intervention. CONCLUSIONS: In complex eyes with prior glaucoma surgery, DMEK offers faster visual recovery, better final visual acuity, and a lower rate of secondary graft failure compared to DSEK during the first postoperative year and beyond. (C) 2019 Published by Elsevier Inc.
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