Graue-Hernandez Enrique O, Zuñiga-Gonzalez Isaac, Hernandez-Camarena Julio C, Jaimes Martha, Chirinos-Saldaña Patricia, Navas Alejandro, Ramirez-Miranda Arturo
Department of Cornea and Refractive Surgery, Instituto de Oftalmologia "Conde de Valenciana", Chimalpopoca 14, 06800 Mexico City, DF, Mexico.
Case Rep Ophthalmol Med. 2012;2012:916528. doi: 10.1155/2012/916528. Epub 2012 Dec 5.
Purpose. To report a case of severe corneal thinning secondary to dry eye treated with a tectonic Descemet stripping automated lamellar keratoplasty (DSAEK) and amniotic membrane graft. Methods. A 72-year-old man with a history of long standing diabetes mellitus type 2 and dry eye presented with 80% corneal thinning and edema on the right eye and no signs of infectious disease, initially managed with topical unpreserved lubrication and 20% autologous serum drops. Eight weeks after, the defect advanced in size and depth until Descemetocele was formed. Thereafter, he underwent DSAEK for tectonic purposes. One month after the procedure, the posterior lamellar graft was well adhered but a 4 mm epithelial defect was still present. A multilayered amniotic membrane graft was then performed. Results. Ocular surface healed quickly and reepithelization occurred over a 2-week period. Eight months after, the ocular surface remained stable and structurally adequate. Conclusion. Tectonic DSAEK in conjunction with multilayered amniotic graft may not only provide structural support and avoid corneal perforation, but may also promote reepithelization and ocular surface healing and decrease concomitant inflammation.
目的。报告一例因干眼症导致严重角膜变薄，采用结构性后弹力层剥除自动板层角膜移植术（DSAEK）和羊膜移植治疗的病例。方法。一名72岁男性，有2型糖尿病和干眼症病史，右眼角膜变薄80%并伴有水肿，无感染性疾病迹象，最初采用局部无防腐剂润滑和20%自体血清滴眼液治疗。八周后，缺损在大小和深度上进一步发展，直至形成后弹力层膨出。此后，为了结构性目的，他接受了DSAEK手术。术后一个月，后板层移植片粘连良好，但仍存在4毫米的上皮缺损。随后进行了多层羊膜移植。结果。眼表迅速愈合，上皮化在2周内完成。八个月后，眼表保持稳定，结构完整。结论。结构性DSAEK联合多层羊膜移植不仅可以提供结构支持，避免角膜穿孔，还可以促进上皮化和眼表愈合，并减轻伴随的炎症。
