Ren Yueping, Zhao Zelin, Shao Yumei, Waller Stephen G, Jhanji Vishal, Chen Wei
School of Ophthalmology and Optometry and Eye Hospital (Y.R., Z.Z., Y.S., W.C.), Wenzhou Medical University, Zhejiang, China; Department of Surgery (S.G.W.), Uniformed Services University of Health Sciences, Bethesda, MD; and Department of Ophthalmology and Vision Science (V.J.), the Chinese University of Hong Kong, Hong Kong, China.
Eye Contact Lens. 2015 Nov;41(6):398-402. doi: 10.1097/ICL.0000000000000156.
To report the outcomes of viscoelastic-aided non-Descemet stripping automated endothelial keratoplasty (nDSAEK) to treat bullous keratopathy in vitrectomized and iris-lens diaphragm injured eyes.
A prospective consecutive case series of eyes with bullous keratopathy underwent nDSAEK. About 0.15 to 0.2 mL cohesive viscoelastic was injected into the anterior chamber in front of the iris defect to prevent air from entering the posterior chamber and vitreous cavity. Filtered air was injected until the intraocular pressure (IOP) rose to a mildly high level. Graft position and complications were monitored postoperatively. Endothelial cell density and best-corrected visual acuity (BCVA) were recorded at a 1-year follow-up.
Viscoelastic-aided nDSAEK was performed in 21 cases (11 males, 10 females; mean age: 58.9±12.4 years). No intraoperative complications were noted. Effective graft adherence was achieved in all cases intraoperatively. Postoperatively, partial graft dislocation was seen in 2 cases because of hypotony (IOP, 6 and 5 mm Hg, respectively) due to postoperative cyclodialysis as demonstrated on anterior segment optical coherence tomography. Hypotony was successfully managed conservatively with spontaneous graft reattachment. One year postoperatively, the median BCVA improved to 20/50. The mean endothelial cell loss was 14.7±12.6% and 20.5±11.1% at 6 months and 1 year, respectively.
In vitrectomized and iris-lens diaphragm injured eyes, viscoelastic-aided nDSAEK effectively facilitated graft adherence and reduced graft dislocation. Appropriate control of IOP was considered to play a vital role in supporting the graft adherence.
报告黏弹剂辅助下非后弹力层剥除自动内皮角膜移植术（nDSAEK）治疗玻璃体切除及虹膜 - 晶状体膈损伤眼大泡性角膜病变的疗效。
对大泡性角膜病变患者进行前瞻性连续病例系列研究，行nDSAEK。在虹膜缺损前方的前房内注入约0.15至0.2 mL黏性黏弹剂，以防止空气进入后房和玻璃体腔。注入过滤空气直至眼压升至轻度高水平。术后监测植片位置及并发症。随访1年时记录内皮细胞密度和最佳矫正视力（BCVA）。
21例（男11例，女10例；平均年龄：58.9±12.4岁）患者接受了黏弹剂辅助下nDSAEK。术中未发现并发症。所有病例术中均实现了有效的植片附着。术后，2例因前段光学相干断层扫描显示的术后睫状体脱离导致低眼压（眼压分别为6和5 mmHg）出现部分植片脱位。低眼压经保守治疗成功实现了植片自发重新附着。术后1年，BCVA中位数提高到20/50。6个月和1年时内皮细胞平均损失分别为14.7±12.6%和20.5±11.1%。
在玻璃体切除及虹膜 - 晶状体膈损伤眼中，黏弹剂辅助下nDSAEK有效促进了植片附着并减少了植片脱位。适当控制眼压被认为对支持植片附着起着至关重要的作用。
