分割角膜移植片を用いたデスメット膜内皮角膜形成術．タンポネード材料と内皮保存時間の影響

Descemet's Membrane Endothelial Keratoplasty with Split Corneal Grafts: The Influence of Tamponade Material and Endothelial Storage Time.

• Selim Genc
• Beril Tulu Aygun
• Fehim Esen
• Yusuf Yildirim
• Alper Agca

抄録

:本研究の目的は、分割角膜移植片を用いたDescemet膜内皮角膜形成術（DMEK）の臨床成績を記述し、タンポネード材料と内皮保存時間がDMEKの成功に及ぼす影響を評価することであった。DMEKの最も一般的な適応は偽水疱性角化症（n = 25, 58.2%）であった。10例（23.2％）で再灌流が必要となり、2例で再DMEK、4例で貫通角膜形成術が予定されていた（9.3％）。BCVAは術後に有意に改善した（＜0.001）。エアタンポナーデと比較して、20％SF6群の方が再バブル率が低く、長期的な解剖学的転帰が良好であるという取るに足らない傾向が見られた（=0.18、=0.25）。早期内皮移植群（24時間未満）と遅発性内皮移植群（3～14日）の間には、解剖学的成功、角膜厚さ、BCVAに有意な差はなかった（＝0.94、＝0.13、＝0.35） : DMEKの成功率は、分割角膜移植で満足のいくものであった。遅発性内皮移植の臨床転帰への悪影響はなかった。20%SF6タンポナーデの成功率は室内空気よりもわずかに良好であった。

: The aim of this study was to describe the clinical outcome of Descemet's membrane endothelial keratoplasty (DMEK) performed with split corneal grafts and to evaluate the influence of tamponade material and endothelial storage time on DMEK success. : The records of 43 patients who underwent DMEK surgery with a split corneal graft were reviewed. Diagnosis of the patients, preoperative and postoperative best-corrected visual acuity (BCVA), corneal and endothelial storage time, tamponade material, complications, and success rates were specifically tabulated. : The most common indication for DMEK was pseudophakic bullous keratopathy (n = 25, 58.2%). Re-bubbling was needed in 10 cases (23.2%), and a re-DMEK was scheduled in 2 cases and penetrating keratoplasty in 4 cases (9.3%). BCVA improved significantly postoperatively ( < .001). There was an insignificant trend towards a lower re-bubbling rate and better long-term anatomic outcome in favor of 20% SF6 group compared to air tamponade ( = .18 and = .25). There was no significant difference between the early endothelial transplant (<24 h) and delayed endothelial transplant (3 to 14 days) groups for anatomic success, corneal thickness or BCVA ( = .94, = .13 and = .35). : The success rate of DMEK was satisfactory with split corneal grafts. There was no adverse influence of delayed endothelial transplantation on clinical outcome. The success rate of 20% SF6 tamponade was slightly better than room air.