Kolomeyer Anton M, Chu David S
The Institute of Ophthalmology and Visual Science, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103, USA.
Case Rep Ophthalmol Med. 2013;2013:697403. doi: 10.1155/2013/697403. Epub 2013 Apr 27.
Purpose. To report the use of Descemet stripping endothelial keratoplasty (DSEK) in a patient with keratoglobus and chronic hydrops. Case Report. We describe a case of a 28-year-old man with bilateral keratoglobus and chronic hydrops in the right eye secondary to spontaneous Descemet membrane tear. The patient presented with finger counting (CF) vision, itching, foreign body sensation, and severe photophobia in the right eye. Peripheral corneal thinning with central corneal protrusion and Descemet membrane tear spanning from 4 to 7 o'clock was noted on slit lamp examination. The right eye cornea was 15 mm in the horizontal diameter. After a 5.5-month loss to follow-up, the patient presented with discomfort, photophobia, decreasing vision, and tearing in the right eye. Vision was 20/60 with pinhole. 360-degree peripheral corneal ectasia with mild neovascularization and hydrops was present. Over the next few months, the patient complained of photophobia and intermittent eye pain. His vision deteriorated to CF, he developed corneal scarring with bullae, and a DSEK was performed. Eight months postoperatively, best-corrected vision improved to 20/30, cornea was clear, and the DSEK graft was stable. Conclusions. Nonresolving hydrops secondary to Descemet membrane tear in a patient with keratoglobus may result in permanent endothelial cell damage and scar formation. This may be successfully treated with DSEK.
目的。报告在一名圆锥角膜合并慢性角膜水肿患者中使用后弹力层剥除内皮角膜移植术（DSEK）的情况。病例报告。我们描述了一名28岁男性患者，双眼圆锥角膜，右眼因自发性后弹力层撕裂继发慢性角膜水肿。患者右眼视力为指数（CF），伴有瘙痒、异物感和严重畏光。裂隙灯检查发现周边角膜变薄，中央角膜前突，后弹力层撕裂范围从4点至7点。右眼角膜水平直径为15毫米。在失访5.5个月后，患者右眼出现不适、畏光、视力下降和流泪。针孔视力为20/60。存在360度周边角膜扩张，伴有轻度新生血管和角膜水肿。在接下来的几个月里，患者主诉畏光和间歇性眼痛。其视力恶化为指数，角膜出现瘢痕伴水泡，遂行DSEK手术。术后8个月，最佳矫正视力提高到20/30，角膜透明，DSEK植片稳定。结论。圆锥角膜患者因后弹力层撕裂导致的持续性角膜水肿可能会导致永久性内皮细胞损伤和瘢痕形成。这可以通过DSEK成功治疗。
