Ravinet E, Tritten J J, Roy S, Gianoli F, Wolfensberger T, Schnyder C, Mermoud A
Hôpital Jules Gonin, Lausanne, Switzerland and Hôpital de la Ville, La Chaux-de-Fonds, Switzerland.
J Glaucoma. 2002 Jun;11(3):244-52. doi: 10.1097/00061198-200206000-00014.
To make surgeons performing nonpenetrating filtering surgery aware of an unusual complication namely Descemet membrane detachment.
We retrospectively reviewed nine eyes of nine patients seen in our hospital with Descemet membrane detachment occurring after nonpenetrating filtering surgery from January 1994 to December 2000.
Both planar and nonplanar detachments were reported. Neither scrolls nor tears in the Descemet membrane were observed in any patient. After viscocanalostomy (four patients), the detachment was generally noticed shortly after the procedure and the cornea maintained its clarity. After deep sclerectomy with a collagen implant (five patients), it developed weeks to months postoperatively with adjacent corneal edema. Four patients had descemetopexy. None required more than one procedure. However, at the last visit, two detachments persisted although they had diminished in size: one after viscocanalostomy and conservative treatment and one after descemetopexy after deep sclerectomy with a collagen implant. To date otherwise, no signs of significant corneal damage could be observed clinically nor by specular microscopy and pachymetry.
The diagnosis of Descemet membrane detachment can be easily overlooked or misdiagnosed. The clinical presentation, clinical course, and pathogenesis depend on the type of nonpenetrating filtering surgery performed. Ophthalmologists should be aware of this unusual complication, which is likely to be more common after nonpenetrating filtering surgery than after trabeculectomy. A period of observation before attempting descemetopexy is recommended.
使进行非穿透性滤过手术的外科医生了解一种不寻常的并发症，即后弹力层脱离。
我们回顾性分析了1994年1月至2000年12月在我院接受非穿透性滤过手术后发生后弹力层脱离的9例患者的9只眼。
报告了平面和非平面脱离。所有患者均未观察到后弹力层的卷曲或撕裂。在房角切开术（4例患者）后，通常在手术后不久就注意到脱离，角膜保持透明。在使用胶原植入物的深层巩膜切除术后（5例患者），脱离在术后数周至数月出现，并伴有相邻角膜水肿。4例患者进行了后弹力层固定术。无一例需要进行超过一次的手术。然而，在最后一次随访时，有2例脱离尽管尺寸减小但仍然存在：1例在房角切开术和保守治疗后，1例在使用胶原植入物的深层巩膜切除术后进行后弹力层固定术后。迄今为止，在临床、镜面显微镜检查和角膜厚度测量中均未观察到明显角膜损伤的迹象。
后弹力层脱离的诊断很容易被忽视或误诊。临床表现、临床过程和发病机制取决于所进行的非穿透性滤过手术的类型。眼科医生应意识到这种不寻常的并发症问题，它在非穿透性滤过手术后可能比小梁切除术后更常见。建议在尝试进行后弹力层固定术前进行一段时间的观察。
