Zaki A A, Elalfy M S, Said D G, Dua H S
Research Institute of Ophthalmology, Cairo, Egypt.
1] Research Institute of Ophthalmology, Cairo, Egypt [2] Academic Ophthalmology, Division of Clinical Neuroscience, B Floor, Eye ENT Centre, Queens Medical Centre, University of Nottingham, Nottingham, UK.
Eye (Lond). 2015 Mar;29(3):323-6. doi: 10.1038/eye.2014.273. Epub 2014 Oct 31.
To describe a technique which exploits the transparency and toughness of the pre-Descemets layer (Dua's layer) to safely perform deep anterior lamellar keratoplasty (DALK) and phacoemulsification at the same time.
Three DALK procedures combined with phacoemulsification were performed by the same surgeon using the big-bubble (BB) technique at the Research Institute of Ophthalmology, Cairo, Egypt. In two cases a type-1 BB, baring Dua's layer, was achieved and in one case a type-2 BB, baring the Descemet's membrane (DM), was achieved. The surgeries were video recorded and photo slit-lamp images were taken in the follow-up visits.
DALK with phacoemulsification and lens implant was carried out in both patients where a type-1 BB was achieved. At a follow up of 18 months (first case) and 6 months (second case), the best corrected vision was 6/12 for each. In the case where a type-2 BB was achieved, the DM ruptured during injection of viscoelastic prior to capsulorhexis. The procedure was converted to a penetrating keratoplasty without phacoemulsification.
When a type-1 BB is achieved simultaneous DALK and phacoemulsification can be safely accomplished. Dua's layer allows a clear view for performing phacoemulsification with the added benefit of its toughness, which can maintain a stable anterior chamber for cataract surgery. This should not be attempted when a type-2 BB is achieved.
描述一种利用前弹力层（杜阿层）的透明性和韧性，同时安全地进行深板层角膜移植术（DALK）和超声乳化术的技术。
埃及开罗眼科研究所的同一位外科医生使用大泡（BB）技术进行了3例DALK联合超声乳化手术。其中2例实现了暴露杜阿层的1型大泡，1例实现了暴露后弹力层（DM）的2型大泡。手术过程进行了录像，并在随访中拍摄了裂隙灯照片。
在实现1型大泡的2例患者中均进行了DALK联合超声乳化和晶状体植入术。随访18个月（第一例）和6个月（第二例）时，每例患者的最佳矫正视力均为6/12。在实现2型大泡的病例中，在撕囊前注射粘弹剂时DM破裂。手术改为未进行超声乳化的穿透性角膜移植术。
当实现1型大泡时，可安全地同时完成DALK和超声乳化术。杜阿层为超声乳化提供清晰视野，其韧性还有额外益处，即能在白内障手术中维持稳定的前房。当实现2型大泡时不应尝试此操作。
