Hayashi Takahiko, Oyakawa Itaru, Kato Naoko
*Department of Ophthalmology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan; †Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan; ‡Department of Ophthalmology, Heart Life Hospital, Okinawa, Japan; §Department of Ophthalmology, Ryukyu University, Okinawa, Japan; and ¶Department of Ophthalmology, Saitama Medical University, Saitama, Japan.
Cornea. 2017 Mar;36(3):390-393. doi: 10.1097/ICO.0000000000001093.
To describe several essential surgical techniques that overcome difficulties in performing Descemet membrane endothelial keratoplasty (DMEK) for inexperienced surgeons, especially those who perform DMEK on eyes of Asian patients.
Nine eyes of 9 Asian patients with bullous keratopathy who underwent DMEK were analyzed retrospectively. All patients were given a diuretic such as D-mannitol or acetazolamide shortly before surgery, with retrobulbar anesthesia and a Nadbath facial nerve block. Core vitrectomy before DMEK was performed in several cases in which a high vitreous pressure during surgery was predicted. The donor graft was stained with trypan blue, and a 25-G anterior chamber maintenance cannula was used to maintain the anterior chamber depth during graft insertion in all eyes.
The cornea became clear in all eyes. The best spectacle-corrected visual acuity had improved significantly 6 months after the surgery compared with preoperative values (P = 0.026). The corneal endothelial cell density was 1371 cells per square millimeter at postoperative 6 months.
Although DMEK is technically difficult, especially for inexperienced surgeons who operate on eyes of Asian patients, controlling anterior chamber pressure using various manipulations may help to prevent iatrogenic primary graft failure and lead to successful DMEK.
描述几种基本的手术技巧，以帮助经验不足的外科医生克服在进行Descemet膜内皮角膜移植术（DMEK）时遇到的困难，特别是那些为亚洲患者的眼睛进行DMEK手术的医生。
回顾性分析9例接受DMEK手术的亚洲大疱性角膜病变患者的9只眼睛。所有患者在手术前不久均给予利尿剂，如D-甘露醇或乙酰唑胺，并进行球后麻醉和Nadbath面神经阻滞。在预计手术期间玻璃体压力较高的几例病例中，在DMEK手术前进行了核心玻璃体切除术。所有眼睛的供体移植物均用台盼蓝染色，并在移植物植入期间使用25G前房维持套管来维持前房深度。
所有眼睛的角膜均变清晰。与术前值相比，术后6个月最佳矫正视力有显著改善（P = 0.026）。术后6个月角膜内皮细胞密度为每平方毫米1371个细胞。
尽管DMEK技术难度较大，尤其是对于为亚洲患者眼睛做手术的经验不足的外科医生，但通过各种操作控制前房压力可能有助于预防医源性原发性移植物失败，并实现DMEK手术的成功。
