*University of Miami, Miller School of Medicine, Miami, FL; †Bascom Palmer Eye Institute, Miami, FL; ‡Biomedical Atomic Force Microscopy Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL; and §University of Crete, Crete, Greece.
Cornea. 2013 Nov;32(11):1512-3. doi: 10.1097/ICO.0b013e3182a1bc49.
To report a case of interface deposits after Descemet stripping automated endothelial keratoplasty (DSAEK) imaged by means of an electron microscope.
An 88-year-old man was referred with a history of corneal edema resulting from pseudophakic bullous keratopathy. A DSAEK was performed on his left eye without complications; however, the follow-up examination revealed a well-attached graft with persistent interface opacities at the donor-recipient interface. The DSAEK was repeated in this eye 1 year after the first surgery because of these corneal opacities that interfered with his vision.
In the immediate postoperative period, the patient had adequate visual acuity with intact graft placement and a clear interface. Pathology and electron microscope analysis were performed on the removed endothelial graft, which revealed diffuse particles on the stromal surface of the endothelial graft.
A repeated DSAEK procedure sufficiently removed this patient's corneal opacities and improved the visual acuity. The opacity is believed to have occurred because of residual viscoelastic material, which was used to maintain anterior chamber volume during surgery. This solution must be thoroughly removed to avoid similar complications.
通过电子显微镜报告一例 Descemet 撕囊自动内皮角膜移植术（DSAEK）后界面沉积物的病例。
一位 88 岁男性因后发性白内障性大泡性角膜病变导致角膜水肿而就诊。左眼行 DSAEK 手术，过程顺利；但随访检查发现供体-受体界面处移植片贴合良好，但仍存在界面混浊。由于这些混浊影响了视力，1 年后再次对左眼行 DSAEK。
术后即刻，患者视力良好，移植片位置正常，界面清晰。对切除的内皮移植物进行了病理和电子显微镜分析，结果显示内皮移植物的基质表面有弥漫性颗粒。
重复 DSAEK 手术足以清除该患者的角膜混浊并提高视力。混浊的发生可能是由于手术过程中为维持前房容积而使用的剩余粘弹剂，必须彻底清除这些物质以避免类似的并发症。
