Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Cornea. 2010 Dec;29(12):1428-9. doi: 10.1097/ICO.0b013e3181cda279.
To report 6 cases of apparently inseparable corneal lamellae during intraoperative preparation of tissue for Descemet stripping automated endothelial keratoplasty (DSAEK).
Collection of clinical case reports from an e-mail survey of The Cornea Society and endothelial keratoplasty discussion group participants and Eye Bank Association of America member eye banks.
Five cases involved eye bank precut tissue. Surgery was aborted in 4 of these cases. In the fifth case, a free anterior cap was identified and the posterior lamella was successfully transplanted. In 1 case, in which an incomplete lamellar cut was made in the operating room, the surgery was continued after manual completion of the lamellar dissection.
The most likely causes of inability to separate the lamellae after punching a DSAEK donor cornea are a decentered or incomplete lamellar cut and unsuspected premature separation of the lamellae. Premature separation can occur with an anterior cap that detaches before the central trephination or a posterior lamella that is inadvertently removed from the field after the central trephination. Careful inspection of the donor cornea under the operating microscope can reduce the risk of a decentered cut and can identify the presence of both lamellae. DSAEK may be completed successfully with an intact posterior lamella.
报告 6 例在准备用于去表皮角膜内皮移植术（DSAEK）的组织时，角膜层间似乎无法分离的病例。
通过对角膜协会和内皮角膜移植讨论组参与者以及美国眼库协会成员眼库的电子邮件调查收集临床病例报告。
5 例涉及眼库预切割组织。其中 4 例手术被中止。在第 5 例中，发现了一个游离的前帽，并成功移植了后层。在 1 例手术中，在手术室中进行了不完全的层间切割，在手动完成层间解剖后继续进行手术。
在打孔 DSAEK 供体角膜后无法分离层间的最可能原因是偏心或不完全的层间切割以及未预料到的层间过早分离。在前帽在中央环钻之前分离或在后层在中央环钻后意外从视野中移除时，可能会发生过早分离。在手术显微镜下仔细检查供体角膜可以降低偏心切割的风险，并可以识别两个层间的存在。如果后层完整，DSAEK 可能会成功完成。
