.: ORİJİNAL ARAŞTIRMA
Desme Membran Endotelyal Keratoplastide Kombine Katarakt Cerrahisinin Greft Sağkalımına Etkisi: Karşılaştırmalı Klinik Çalışma
The Effect of Combined Cataract Surgery on Graft Survival in Descemet's Membrane Endothelial Keratoplasty: A Comparative Clinical Study
Turkiye Klinikleri J Ophthalmol. 2021;30(3):155-62
doi: 10.5336/ophthal.2020-78329
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Fuchs endotelyal distrofili (FED) olguların tedavisinde üçlü kombine cerrahi yöntem ile yalnız Desme membran endotelyal keratoplasti (DMEK) işleminin uzun dönem sonuçlarının ve greft sağkalımının karşılaştırılması. Gereç ve Yöntemler: Beyoğlu Göz Eğitim ve Araştırma Hastanesi Kornea Biriminde 2016 ve 2019 yılları arasında FED tanısıyla üçlü kombine yöntem (fakoemülsifikasyon-göz içi lens yerleştirilmesi-DMEK) ve yalnız DMEK yapılan 54 hastanın dosyası geriye dönük olarak incelendi. Olgular, uygulanan cerrahi yönteme göre 2 gruba ayrıldı. Grup 1 psödofakik FED olup yalnız DMEK prosedürü uygulanan 28 olgudan, Grup 2 üçlü kombine yöntem tercih edilen 26 olgudan oluşturuldu. İşlem öncesi demografik veriler, en iyi düzeltilmiş görme keskinliği (EİDGK) ile işlem sonrası EİDGK, endotel hücre yoğunluğu ve komplikasyonlar değerlendirildi. Bulgular: Olguların ortalama yaşı Grup 1'de 61,82±12,75 yıl, Grup 2'de 69,15±12,99 yıl (p=0,041) ve ortalama takip süresi Grup 1'de 43,29±21,60 ay, Grup 2'de 40,23±23,97 ay idi (p=0,624). Cerrahi sonrası 1 ve 6. aydaki EİDGK ölçümlerinde gruplar arasındaki fark istatistiksel olarak anlamlıydı (sırasıyla p=0,009, p=0,020). Bir, 2 ve 3. yıl yapılan EİDGK ölçümlerinde 2 grup arasında istatistiksel olarak anlamlı fark bulunmadı (sırasıyla p=0,151, p=0,311, p=0,519). Tüm vizitlerde 2 grup arasında endotel hücre yoğunluğu azalma oranları arasında anlamlı istatistiksel fark bulunmadı (p˃0,05). İki grubun greft sağkalım oranları karşılaştırıldığında istatistiksel olarak anlamlı fark saptanmadı. (Logrank 0,031, p=0,860). Sonuç: FED olgularında tedavide uygulanan üçlü kombine yaklaşım ve tek başına DMEK cerrahisi arasında, uzun dönemli sonuçlar ve greft sağkalım oranları açısından anlamlı fark bulunmamıştır.
Anahtar Kelimeler: Desme membran endotelyal keratoplasti; fakoemülsifikasyon; Fuchs endotelyal distrofi
Amaç: Fuchs endotelyal distrofili (FED) olguların tedavisinde üçlü kombine cerrahi yöntem ile yalnız Desme membran endotelyal keratoplasti (DMEK) işleminin uzun dönem sonuçlarının ve greft sağkalımının karşılaştırılması. Gereç ve Yöntemler: Beyoğlu Göz Eğitim ve Araştırma Hastanesi Kornea Biriminde 2016 ve 2019 yılları arasında FED tanısıyla üçlü kombine yöntem (fakoemülsifikasyon-göz içi lens yerleştirilmesi-DMEK) ve yalnız DMEK yapılan 54 hastanın dosyası geriye dönük olarak incelendi. Olgular, uygulanan cerrahi yönteme göre 2 gruba ayrıldı. Grup 1 psödofakik FED olup yalnız DMEK prosedürü uygulanan 28 olgudan, Grup 2 üçlü kombine yöntem tercih edilen 26 olgudan oluşturuldu. İşlem öncesi demografik veriler, en iyi düzeltilmiş görme keskinliği (EİDGK) ile işlem sonrası EİDGK, endotel hücre yoğunluğu ve komplikasyonlar değerlendirildi. Bulgular: Olguların ortalama yaşı Grup 1'de 61,82±12,75 yıl, Grup 2'de 69,15±12,99 yıl (p=0,041) ve ortalama takip süresi Grup 1'de 43,29±21,60 ay, Grup 2'de 40,23±23,97 ay idi (p=0,624). Cerrahi sonrası 1 ve 6. aydaki EİDGK ölçümlerinde gruplar arasındaki fark istatistiksel olarak anlamlıydı (sırasıyla p=0,009, p=0,020). Bir, 2 ve 3. yıl yapılan EİDGK ölçümlerinde 2 grup arasında istatistiksel olarak anlamlı fark bulunmadı (sırasıyla p=0,151, p=0,311, p=0,519). Tüm vizitlerde 2 grup arasında endotel hücre yoğunluğu azalma oranları arasında anlamlı istatistiksel fark bulunmadı (p˃0,05). İki grubun greft sağkalım oranları karşılaştırıldığında istatistiksel olarak anlamlı fark saptanmadı. (Logrank 0,031, p=0,860). Sonuç: FED olgularında tedavide uygulanan üçlü kombine yaklaşım ve tek başına DMEK cerrahisi arasında, uzun dönemli sonuçlar ve greft sağkalım oranları açısından anlamlı fark bulunmamıştır.
Anahtar Kelimeler: Desme membran endotelyal keratoplasti; fakoemülsifikasyon; Fuchs endotelyal distrofi
ABSTRACT
Objective: Long-term results and graft survival in patients with and without combined cataract surgery with Descemet membrane endothelial keratoplasty (DMEK) in Fuchs endothelial dystrophy (FED) were compared. Material and Methods: Retrospectively, the files of 54 patients with an FED diagnosis of between 2016 and 2019 who underwent a triple combined method (phacoemulsification-intraocular lens implantation-DMEK) and those who underwent only DMEK in the Cornea Unit of Beyoğlu Eye Training and Research Hospital were examined. The patients were divided into two groups according to surgical method; Group 1 consisted of 28 cases with pseudophakic FED who underwent DMEK procedure only, and Group 2 consisted of 26 cases who underwent the triple combined method. Preoperative demographic data, baseline and post-operative values for best-corrected visual acuity (BCVA), endothelial cell density, and complications were evaluated. Results: The mean ages of the patients was 61.82±12.75 and 69.15±12.99 years in groups 1 and 2 (p=0.041), respectively. Mean follow-up time was 43.29±21.60 and 40.23±23.97 months Group 1 and Group 2 (p=0.624), respectively. The difference between the groups in BCVA measurements at the postoperative first and sixth months was statistically significant (p=0.009 and p=0.020, respectively). No statistically significant difference was found between the two groups in the 1st, 2nd and 3rd year BCVA measurements (p=0.151, p=0.311, p=0.519 respectively). The difference between the decrease in endothelial cell density between the two groups at all visits was not statistically significant (p˃0.05). When the graft survival rates of the two groups up to 36 months were compared, no statistically significant difference was noted (Logrank 0.031, p=0.860). Conclusion: There were no significant difference in long-term results and graft survival rates between the triple combined and single DMEK methods in FED treatment.
Keywords: Descemet membrane endothelial keratoplasty; phacoemulsification; Fuchs' endothelial dystrophy
Objective: Long-term results and graft survival in patients with and without combined cataract surgery with Descemet membrane endothelial keratoplasty (DMEK) in Fuchs endothelial dystrophy (FED) were compared. Material and Methods: Retrospectively, the files of 54 patients with an FED diagnosis of between 2016 and 2019 who underwent a triple combined method (phacoemulsification-intraocular lens implantation-DMEK) and those who underwent only DMEK in the Cornea Unit of Beyoğlu Eye Training and Research Hospital were examined. The patients were divided into two groups according to surgical method; Group 1 consisted of 28 cases with pseudophakic FED who underwent DMEK procedure only, and Group 2 consisted of 26 cases who underwent the triple combined method. Preoperative demographic data, baseline and post-operative values for best-corrected visual acuity (BCVA), endothelial cell density, and complications were evaluated. Results: The mean ages of the patients was 61.82±12.75 and 69.15±12.99 years in groups 1 and 2 (p=0.041), respectively. Mean follow-up time was 43.29±21.60 and 40.23±23.97 months Group 1 and Group 2 (p=0.624), respectively. The difference between the groups in BCVA measurements at the postoperative first and sixth months was statistically significant (p=0.009 and p=0.020, respectively). No statistically significant difference was found between the two groups in the 1st, 2nd and 3rd year BCVA measurements (p=0.151, p=0.311, p=0.519 respectively). The difference between the decrease in endothelial cell density between the two groups at all visits was not statistically significant (p˃0.05). When the graft survival rates of the two groups up to 36 months were compared, no statistically significant difference was noted (Logrank 0.031, p=0.860). Conclusion: There were no significant difference in long-term results and graft survival rates between the triple combined and single DMEK methods in FED treatment.
Keywords: Descemet membrane endothelial keratoplasty; phacoemulsification; Fuchs' endothelial dystrophy
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