Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Desme Membran Endotelyal Keratoplasti: Klinik Sonuçlarımız
Descemet Membrane Endothelial Keratoplasty: Our Clinical Results
Yusuf KOÇLUKa, Burcu KASIMa
aGöz Hastalıkları Kliniği, Adana Şehir Eğitim ve Araştırma Hastanesi, Adana, TÜRKİYE
Turkiye Klinikleri J Med Sci. 2019;39(1):33-41
doi: 10.5336/medsci.2018-62305
Article Language: TR
Full Text
ÖZET
 Amaç: Endotel yetmezliği nedeniyle, desme membran endotelyal keratoplasti (DMEK) ve/veya kombine göz içi cerrahi uygulanan olgularda klinik sonuçların sunulması amaçlandı. Gereç ve Yöntemler: Şubat 2014-Şubat 2018 tarihleri arasında DMEK uygulanan 155 hastanın kayıtları retrospektif olarak incelendi. Klinik sonuçlar ve komplikasyonlar değerlendirildi. Bulgular: Ortalama 17,2±6,4 (6-47) ay olan takip süresi sonunda kornea, 136 (%87,7) olguda saydam, 3 (%1,9) olguda yarı-saydam ve 16 (%10,3) olguda ise ödemli olarak tespit edildi. Ameliyat öncesi düzeltilmiş uzak görme keskinliği ortalama 0,022±0,022 (0,001-0,1) iken, takip süresi sonunda 0,46±0,27 (0,001-1,0) olarak tespit edildi. Santral kornea kalınlık değerleri, ameliyat öncesi ortalama 859,0±155,5 μ (643-1890), takip süresi sonunda ise 537,8±79,6 μ (422-890) olarak tespit edildi. Diğer göz içi cerrahiler ile kombine DMEK uygulanan olgular, yalnızca DMEK uygulanan olgular ile karşılaştırıldığında ameliyat sonrası 1.günde greftte periferik ayrılma ve total ayrılma oranları benzer bulunurken, 1.ayda kombine cerrahi uygulanan olgularda greftte periferik ayrılma ve total ayrılma, yalnızca DMEK uygulanan olgulara göre istatistiksel olarak anlamlı fazlaydı. Son kontrol muayenesinde ise her iki grupta greft yatışıklığı benzer olarak izlendi. Sonuç: DMEK, stromal opasifikasyonu bulunmayan ve epitel uzaklaştırılması sonrası ön kamara detaylarının görülebildiği endotel yetmezlikli olgularda başarılı bir yöntemdir.

Anahtar Kelimeler: Desme membran endotelyal keratoplasti; fuchs endotelyal distrofi; psödofakik ve afakik büllöz keratopati; greft yetmezliği; desme membranı
ABSTRACT
 Objective: To present the clinical data of the patients with endothelial dysfunction who underwent Descemet membrane endothelial keratoplasty (DMEK) alone or with either intra ocular surgery. Material and Methods: The clinical data of the cases who underwent DMEK between February 2014 and February 2018 were analyzed retrospectively. Results: The mean follow up was 17.2±6.4 (min:6-max:47) months. At the last follow-up visit, 136 (87.7%) of the patients' corneas were clear, 3 (1.9%) were semiclear and 16 (10.3%) were edematous. The mean best corrected visual acuity was 0.022±0.022 (0.001-0.1) preoperatively and 0.46±0.27 (0.001-1.0) at the last follow-up visit. The mean central corneal thickness was found to be 859.0±155.5 μ (643-1890) preoperatively and 537.8±79.6 μ (422-890) at the last follow-up visit. Peripheral or total detachment of DM graft rates were similar when compared between the patients WHO underwent DMEK alone and combined with other intraocular surgeries on first postoperative day. On the first postoperative month, these rates were found to be higher in the patients who underwent DMEK with other intraocular surgeries. At the last follow-up visit, total graft attachment rate was similar between these two groups. Conclusion: DMEK is a successful surgery in patients with endothelial dysfunction and no stromal opacity in which anterior chamber details can be seen after epithelial debridement.

Keywords: Descemet membrane endothelial keratoplasty; fuchs endothelial dystrophy; pseudophakic and aphakic bullous keratopathy; graft failure; descemet's membrane
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