Mittal Vikas, Mittal Ruchi, Jain Rajat, Sangwan Virender S
Department of Cornea and Anterior Segment Services, Sanjivni Eye Care, Ambala, Haryana, India.
Department of Vitreo-retina Services, Sanjivni Eye Care, Ambala, Haryana, India.
BMJ Case Rep. 2014 Jun 27;2014:bcr2013202935. doi: 10.1136/bcr-2013-202935.
Descemet membrane endothelial keratoplasty (DMEK) was performed in a 70-year-old man diagnosed with pseudophakic bullous keratopathy. During Descemet endothelial complex (DEC) preparation, a central tear was noticed in the DMEK graft. However, the surgery was continued. On sixth postoperative day, a small fluid pocket was observed between the DEC and the posterior host stroma in inferior third of the graft area. It was, however, decided to observe it for spontaneous attachment. At 2 weeks, the inferior DEC detachment had increased with overlying corneal oedema. Descemetopexy with 100% air was performed the same day which reattached the DEC. Subsequently, DEC remained attached and at the last follow-up of 2 months, DEC was well opposed with a clear overlying cornea. The final best-corrected Snellen's visual acuity was 20/60. A small tear in the DEC does not necessitate tissue replacement and a good anatomical and visual outcome can be achieved in such cases.
对一名诊断为人工晶状体眼大泡性角膜病变的70岁男性患者实施了Descemet膜内皮角膜移植术（DMEK）。在制备Descemet内皮复合体（DEC）时，发现DMEK植片中央有一处撕裂。然而，手术仍继续进行。术后第6天，在植片区域下三分之一处的DEC与宿主后基质之间观察到一个小液袋。不过，决定对其进行观察，看是否能自行附着。在术后2周时，下方DEC脱离加重，伴有上方角膜水肿。同一天进行了100%空气的Descemet膜固定术，使DEC重新附着。随后，DEC一直保持附着状态，在最后的2个月随访时，DEC贴合良好，上方角膜透明。最终最佳矫正视力为20/60。DEC中的小撕裂并不一定需要更换组织，此类病例可实现良好的解剖和视觉效果。
