Morkin Melina I, Hussain Rehan M, Young Ryan C, Ravin Tracy, Dubovy Sander R, Alfonso Eduardo C
Department of Ophthalmology, Shiley Eye Center, University of California - San Diego, San Diego, CA, USA ; Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
Clin Ophthalmol. 2014 Aug 28;8:1629-32. doi: 10.2147/OPTH.S65520. eCollection 2014.
A 51-year-old male who had undergone phacoemulsification in his left eye 11 months prior presented with complaint of sudden onset of blurred vision in the same eye. Review of his clinical course, slit-lamp exam, pachymetry, and specular endothelial microscopy led to the diagnosis of acute hydrops caused by Descemet's membrane dehiscence at the site of the incision. He was initially managed with medical treatment and observation. In the subsequent months of follow-up, the corneal edema and the patient's visual acuity did not improve. Intracameral gas injection was performed 7 months after presentation, but because of persistent corneal edema and nonattached Descemet's membrane, penetrating keratoplasty was performed. Histopathologic examination confirmed the diagnosis. The patient has had a clear corneal graft since then. Although Descemet's membrane detachment is a rather common complication after intraocular surgery, its unusually delayed presentation can also occur, and should not be confused with pseudophakic bullous keratopathy. Many mechanisms have been studied for the development of early tears and detachments after cataract surgery, but little is known about late presentations. The authors explore possible causes, and highlight the importance of instructing patients to avoid eye rubbing and any other type of trauma to the cornea after intraocular surgery.
一名51岁男性，11个月前左眼接受了超声乳化白内障吸除术，现因同一眼突然出现视力模糊前来就诊。回顾其临床病程、裂隙灯检查、角膜测厚及角膜内皮镜检查后，诊断为切口部位后弹力层裂开导致的急性角膜水肿。最初对其进行了药物治疗及观察。在随后的几个月随访中，角膜水肿及患者视力均未改善。就诊7个月后进行了前房注气，但由于角膜水肿持续存在且后弹力层未附着，遂行穿透性角膜移植术。组织病理学检查确诊。此后患者角膜移植片保持透明。尽管后弹力层脱离是眼内手术后相当常见的并发症，但其异常延迟出现的情况也可能发生，不应与人工晶状体性大泡性角膜病变相混淆。对于白内障手术后早期撕裂和脱离的发生机制已进行了诸多研究，但对于晚期表现却知之甚少。作者探讨了可能的原因，并强调了指导患者避免揉眼及眼内手术后角膜遭受任何其他类型创伤的重要性。
