臨床眼科73巻4号

2019年04月発行

連載 今月の話題

DMEK—より安全に，より確実に

著者： 親川格¹² 林孝彦³⁴

所属機関： ¹ハートライフ病院眼科 ²琉球大学医学部眼科学教室 ³横浜南共済病院眼科 ⁴横浜市立大学医学部眼科学教室

ページ範囲：P.405 - P.414

　角膜内皮機能不全に対する治療法としてデスメ膜角膜内皮移植術（DMEK）は高い視機能を提供する最も有効な手段である^1〜4）。しかし，その習得・導入においてきついDMEKラーニングカーブがあるのも事実である。本稿では，筆者らが経験した課題や対処法を提示し，これから始める術者にとって，より安全により確実に導入するための一助となるエッセンスを紹介したい。

参考文献

1）Melles GR, Ong TS, Ververs B et al：Preliminary clinical results of Descemet membrane endothelial keratoplasty. Am J Ophthalmol 145：222-227, 2007

2）Anshu A, Price MO, Price FW：Risk of corneal transplant rejection significantly reduced with Descemet's membrane endothelial keratoplasty：Ophthalmology 119：536-540, 2012

）gas. Cornea 34：845-852, 2015

4）Ham L, Dapena I, Liarakos VS et al：Midterm results of Descemet membrane endothelial keratoplasty：4 to 7 years clinical outcome. Am J Ophthalmol 171：113-121, 2016

5）Shimazaki J, Amano S, Uno T et al：National survey on bullous keratopathy in Japan. Cornea 26：274-278, 2007

6）Rudolph M, Laaser K, Bachmann BO et al：Corneal higher-order aberrations after Descemet's membrane endothelial keratoplasty. Ophthalmology 119：528-535, 2012

7）Hayashi T, Yamaguchi T, Yuda K et al：Topographic characteristics after Descemet's membrane endothelial keratoplasty and Descemet's stripping automated endothelial keratoplasty. PLoS One 12. doi：10.1371/journal.pone.0188832, 2017

8）Droutsas K, Lazaridis A, Papaconstantinou D et al：Visual outcomes after descemet membrane endothelial keratoplasty versus descemet stripping automated endothelial keratoplasty-comparison of specific matched pairs. Cornea 35：765-771, 2016

9）Hayashi T, Oyakawa I, Kato N：Techniques for learning Descemet membrane endothelial keratoplasty for eyes of Asian patients with shallow anterior chamber. Cornea 36：390-393, 2016

10）Hayashi T, Yuda K, Oyakawa I et al：Use of brilliant blue G in Descemet's membrane endothelial keratoplasty. Biomed Res Int. doi：10.1155/2017/9720389, 2017

11）Matsuzawa A, Hayashi T, Oyakawa I et al：Use of four asymmetric marks to orient the donor graft during Descemet's membrane endothelial keratoplasty. BMJ Open Ophthalmol 1. doi：10.1136/bmjophth-2017-000080, 2017

12）Shimizu T, Hayashi T, Yuda K et al：Chandelier illumination for Descemet membrane endothelial keratoplasty. Cornea 36：1155-1157, 2017

13）Yamada N, Hayashi T, Yuda K et al：Outcomes of Descemet membrane endothelial keratoplasty for vitrectomized eyes with sutured posterior chamber intraocular lens. J Ophthalmol 11. doi：10.1155/2018/3127126, 2018

14）Hayashi T, Oyakawa I, Matsuzawa A et al：Descemet membrane endothelial keratoplasty using ophthalmic viscoelastic devices for eyes with laser iridotomy-induced corneal endothelial decompensation：analysis of 11 eyes. Medicine（Baltimore） 97. doi：10.1097/MD.0000000000011245, 2018

15）Hayashi T, Kobayashi A：Double-bubble technique in Descemet membrane endothelial keratoplasty for vitrectomized eyes：a case series. Cornea 37：1185-1188, 2018

16）Shimizu T, Hayashi T, Yuda K et al：Short axial length and iris damage are associated with iris posterior synechiae after Descemet membrane endothelial keratoplasty in Asian eyes. Cornea 37：1355-1359, 2018

17）Oyakawa I, Hayashi T, Kobashigawa Y et al：Evaluation of anterior and posterior corneal irregularity after Descemet membrane endothelial keratoplasty. Cornea 37：1360-1365, 2018

18）Livny E, Groeneveld-van Beek EA, Lie JT et al：Minimizing graft preparation failure in Descemet membrane endothelial keratoplasty. Cornea 36：1452-1457, 2017

19）小橋川裕子，親川　格，林　孝彦・他：術中に移植片脱出を生じたDMEKの1例．あたらしい眼科34：568-570，2017

20）Monnereau C, Quilendrino R, Dapena I et al：Multicenter study of descemet membrane endothelial keratoplasty：first case series of 18 surgeons. JAMA Ophthalmol 132：1192-1198, 2014

21）Del Hierro Zarzuelo A, Boto de Los Bueis A：Iris alterations after DSAEK. Arch Soc Esp Oftalmol 91：422-425, 2016

22）Kocaba V, Mouchel R, Fleury J et al：Incidence of cystoid macular edema after Descemet membrane endothelial keratoplasty. Cornea 37：277-282, 2018

23）Deng SX, Lee WB, Hammersmith KM et al：Descemet membrane endothelial keratoplasty：safety and outcomes：a report by the American Academy of Ophthalmology. Ophthalmology 125：295-310, 2018

24）Leon P, Parekh M, Nahum Y et al：Factors associated with early graft detachment in primary Descemet membrane endothelial keratoplasty. Am J Ophthalmol 187：117-124, 2018

25）Crews JW, Price MO, Lautert J et al：Intraoperative hyphema in Descemet membrane endothelial keratoplasty alone or combined with phacoemulsification. J Cataract Refract Surg 44：198-201, 2018

26）Ishii N, Yamaguchi T, Yazu H et al：Factors associated with graft survival and endothelial cell density after Descemet's stripping automated endothelial keratoplasty. Sci Rep. doi：10.1038/srep25276, 2016

27）Dapena I, Moutsouris K, Droutsas K et al：Standardized“no-touch”technique for descemet membrane endothelial keratoplasty. Arch Ophthalmol 129：88-94, 2011

28）Kruse FE, Laaser K, Cursiefen C et al：A stepwise approach to donor preparation and insertion increases safety and outcome of Descemet membrane endothelial keratoplasty. Cornea 30：580-587, 2011

29）Fernández López E, Baydoun L, Gerber-Hollbach N et al：Rebubbling techniques for graft detachment after Descemet membrane endothelial keratoplasty. Cornea 35：759-764, 2016

30）Güell JL, Morral M, Gris O et al：Comparison of sulfur hexafluoride 20％ versus air tamponade in Descemet membrane endothelial keratoplasty. Ophthalmology 122：1757-1764, 2015