Venkatraman Arvind
Dr. Arvind Vision Care, Chennai, Tamilnadu, India.
Oman J Ophthalmol. 2012 May;5(2):112-4. doi: 10.4103/0974-620X.99376.
Deep anterior lamellar keratoplasty (DALK) using Dr. Anwar's big bubble technique was performed for a patient with granular dystrophy. Intraoperatively, a perforation of the Descemet's membrane (DM) was noted inferonasally. Though the surgery was completed, the donor graft appeared to have an intact endothelium, which was inadvertently left behind by the surgeon. Intraoperatively, there was a perforation of inferonasal DM and surgery was completed by inadvertently placing a donor with an intact endothelium. Postoperatively the patient presented with a complete DM detachment and a resultant double anterior chamber (DAC). In spite of two attempts at an air tamponade on the first and fifth post operative days, the DAC still persisted. Surprisingly, during the 6(th) week follow up visit, there was a complete resolution of the DAC as well as total recovery of vision. This interesting case clearly exemplifies that, in spite of failed attempts at air tamponade, a DM detachment and a DAC due to DM perforation following a DALK procedure can resolve spontaneously with good visual outcome.
采用安瓦尔医生的大泡技术为一名颗粒状角膜营养不良患者实施了深板层角膜移植术（DALK）。术中，在鼻下象限发现后弹力层（DM）穿孔。尽管手术完成，但供体植片似乎有完整的内皮，这是外科医生无意中遗留的。术中，鼻下象限的DM发生穿孔，手术通过无意中放置一块具有完整内皮的供体完成。术后患者出现了完全的DM脱离及由此导致的双前房（DAC）。尽管在术后第1天和第5天进行了两次空气填塞尝试，DAC仍然存在。令人惊讶的是，在第6周的随访中，DAC完全消退，视力也完全恢复。这个有趣的病例清楚地表明，尽管空气填塞尝试失败，但DALK手术后因DM穿孔导致的DM脱离和DAC仍可自发消退，并获得良好的视觉效果。
