Vianna Lucas M M, Woreta Fasika, Kiely Amanda E, Jun Albert S
*Department of Ophthalmology, Cornea and Anterior Segment Service, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD; †Department of Ophthalmology, Federal University of São Paulo/Paulista School of Medicine, São Paulo, Brazil; and ‡Department of Ophthalmology, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
Cornea. 2014 Aug;33(8):865-7. doi: 10.1097/ICO.0000000000000162.
The aim of this study was to relate a case of deep anterior lamellar keratoplasty (DALK) converted to penetrating keratoplasty in which the host central Descemet membrane (DM) with a large perforation was left attached to the host cornea.
This is a case report of a 34-year-old man who underwent an attempted DALK for keratoconus in his left eye, which became complicated with a large rupture in DM during dissection. The host DM was left in place, the donor cornea with DM intact was sutured onto the host bed, and air was injected into the anterior chamber. The patient was monitored by biomicroscopy, pachymetry, topography, anterior segment optical coherence tomography, and specular microscopy.
The postoperative course resulted in improved uncorrected visual acuity, best spectacle-corrected visual acuity, and topography. Corneal edema was observed in the host cornea peripheral to the graft. Three months after the surgery, the endothelial cell density was reduced by 63% compared with the preoperative donor cell density.
Leaving the host DM during conversion of DALK to penetrating keratoplasty was uneventful in this case, although corneal edema was observed in the area overlying the host cornea. It is possible that the retained DM could provide additional autologous endothelial cells to prolong graft survival.
本研究旨在报告一例深板层角膜移植术（DALK）转为穿透性角膜移植术的病例，术中保留了带有大穿孔的宿主中央后弹力层（DM）并使其附着于宿主角膜。
这是一例34岁男性患者的病例报告，其左眼因圆锥角膜接受了DALK手术尝试，但在剖切过程中后弹力层出现大的破裂。保留宿主后弹力层，将带有完整后弹力层的供体角膜缝合到宿主植床上，并向前房注入空气。通过生物显微镜检查、角膜测厚、地形图检查、眼前节光学相干断层扫描和镜面显微镜检查对患者进行监测。
术后过程中，患者的裸眼视力、最佳矫正视力和地形图均有所改善。在移植片周边的宿主角膜中观察到角膜水肿。术后三个月，内皮细胞密度与术前供体细胞密度相比降低了63%。
在本病例中，DALK转为穿透性角膜移植术时保留宿主后弹力层的过程顺利，尽管在宿主角膜上方区域观察到了角膜水肿。保留的后弹力层有可能提供额外的自体内皮细胞以延长移植片的存活时间。
