Cornea Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.
Cornea. 2013 Mar;32(3):355-8. doi: 10.1097/ICO.0b013e31825cea80.
To report a case of corneal hydrops in a patient with keratoglobus that was managed with endothelial keratoplasty to achieve corneal stability and prevent a limbus-to-limbus tear in Descemet membrane.
A 30-year-old man with keratoglobus presented with corneal hydrops in his left eye resulting from a central vertical tear in Descemet membrane. His other eye had been previously treated with penetrating keratoplasty using a large graft (an 11-mm donor graft to a 10-mm recipient bed) because of a limbus-to-limbus tear in Descemet membrane without resolution of his edema. An attempt to approximate the edges of the Descemet tear in the left eye by an intracameral air injection failed, and the tear continued to progress peripherally. An endothelial keratoplasty button with anchoring sutures was placed over the Descemet tear because of excessive localized edema.
One month after insertion of the sutured endothelial keratoplasty button, the edema had resolved, and 1 year later, the tear remains sealed. The patient's visual acuity improved from counting fingers at 1 foot to 20/100.
Reconstitution of the posterior corneal surface in keratoglobus-induced hydrops can be achieved with endothelial keratoplasty over the Descemet tear. Preventing progression of a central Descemet tear is essential to bypass the need for a large-diameter penetrating keratoplasty graft and its complications in a young patient with a history of bilateral corneal hydrops.
报告 1 例圆锥角膜患者发生角膜水肿，行内皮角膜移植术以稳定角膜，防止角膜后弹力层撕裂至角膜缘。
1 名 30 岁男性因角膜后弹力层中央垂直撕裂导致左眼角膜水肿，曾行穿透性角膜移植术治疗右眼，因角膜后弹力层撕裂未愈合伴水肿，当时采用了大直径供体（11mm 供体移植至 10mm 受区）。行房内空气注射试图使左眼角膜后弹力层撕裂边缘接近，但撕裂继续向周边进展。因局部水肿严重，在撕裂区行内皮角膜移植纽扣缝合术。
缝合内皮角膜移植纽扣后 1 个月，水肿消退，1 年后撕裂仍封闭。患者视力从眼前指数提高到 20/100。
对于圆锥角膜相关性水肿，可通过角膜后弹力层撕裂区的内皮角膜移植术重建后角膜表面。对于双侧角膜水肿病史的年轻患者，预防中央角膜后弹力层撕裂进展至关重要，可以避免大直径穿透性角膜移植术及其并发症。
