Deux patients de notre étude (9,5%), un de chaque groupe, ont présenté une hypertonie cortisonée six mois après la greffe. Celle-ci a été résolutive avec la décroissance de la corticothérapie locale et un traitement hypotonisant local.
L’hypertonie après greffe endothéliale varie dans la littérature de 0 à 54% des patients avec un taux moyen de 3% (2, 12). Elle est corrélée à la durée du traitement local par corticoïdes (93) et est favorisée par une hypertonie préexistante (94).
! '%! Il est à noter que même si la greffe endothéliale modifie la pachymétrie cornéenne, il n’y a pas de correction à apporter à la tension oculaire mesurée (95).
Au total, il n’y a pas eu de différence significative entre les complications survenues dans le groupe A et dans le groupe B.
! '&!
Conclusion
Ces dernières années, les greffes endothéliales ont révolutionné la prise en charge des pathologies cornéennes endothéliales. Elles permettent en effet à des patients de récupérer une bonne transparence cornéenne tout en préservant leur architecture cornéenne.
Les différentes études ont tendance à montrer que plus le greffon endothélial est fin, meilleure la récupération visuelle est. Cependant les greffes endothéliales pures sont techniquement difficiles à réaliser, notamment lorsque la visibilité per opératoire est limitée et lorsqu’il existe certaines pathologies oculaires.
Notre étude, comparant une technique classique de préparation automatique du greffon à une technique manuelle de préparation de greffon ultrafin, tend à montrer un avantage de la technique manuelle. Celle-ci permettrait une récupération visuelle meilleure et plus rapide, avec une meilleure densité endothéliale post opératoire, tout en conservant les avantages de la technique classique en terme de déroulement de la chirurgie et de complications.
La greffe ultrafine préparée manuellement est donc une bonne alternative à la DMEK, notamment lorsqu’il existe des co-morbidités oculaires rendant la DMEK difficile de réalisation.
! ''!
Bibliographie
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! (#! Annexe n°1 : Table de conversion entre les acuités visuelles en Monoyer, ETDRS et logMar
Table de correspondance entre les différentes notations de l’acuité visuelle en vision de loin
angle visuel minutes d'arc valeur logMAR notation Monoyer (1) fraction décimale (2) notation de Snellen distance de mesure à : score ETDRS
notation indépendante de la distance notation dépendante de la distance notation indépendante
de la distance
4 mètres 5 mètres 6 mètres 20 pieds
120 1/120 0,008 20/2400 100 + 2 1/100 (CLD à 30 cm) 0,010 20/2000 80 1/80 0,0125 4/320 6/480 20/1600 60 1/60 0,016 20/1200 50 1/50 (CLD à 1 m) 0,020 20/1000 40 1/40 0,025 4/160 6/240 20/800 5 30 1/30 0,033 4/120 20/600 10 25 1/25 0,04 4/100 20/500 15 20 + 1,3 1/20 0,05 4/80 5/100 6/120 20/400 20 16 + 1,2 1/16 0,063 (0,06) 4/63 5/80 6/95 20/320 25 12,50 + 1,1 1/12 0,08 4/50 5/63 6/75 20/250 30 10 + 1 1/10 0,10 4/40 5/50 6/60 20/200 35 8 + 0,9 1,25/10 0,125 4/32 5/40 6/48 20/160 40 6,30 + 0,8 1,6/10 0,16 4/25 5/32 6/38 20/125 45 5 + 0,7 2/10 0,20 4/20 5/25 6/30 20/100 50 4 + 0,6 2,5/10 0,25 4/16 5/20 6/24 20/80 55 3,20 + 0,5 3,2/10 0,32 (0,3) 4/12,5 5/16 6/19 20/63 60 2,50 + 0,4 4/10 0,40 4/10 5/12,5 6/15 20/50 65 2 + 0,3 5/10 0,50 4/8 5/10 6/12 20/40 70 1,60 + 0,2 6,3/10 0,63 (0,6) 4/6,3 5/8 6/9,5 20/32 75 1,25 + 0,1 8/10 0,80 4/5 5/6,3 6/7,5 20/25 80 1 0 10/10 1 4/4 5/5 6/6 20/20 85 0,80 - 0,1 12,5/10 1,25 4/3,2 5/4 6/4,8 20/16 90 0,63 - 0,2 16/10 1,6 4/2,5 5/3,2 6/3,8 20/12,5 95 0,50 - 0,3 20/10 2 4/2 5/2,5 6/3 20/10 100
! ($! Annexe n°2 : Présentation des différents milieux Eurobio utilisés pour la conservation des