Einan-Lifshitz Adi, Sorkin Nir, Boutin Tanguy, Mednick Zale, Kreimei Mohammad, Chan Clara C, Rootman David S
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
Cornea. 2018 Jun;37(6):682-686. doi: 10.1097/ICO.0000000000001550.
To suggest a new surgical approach for posterior opacities or persistent Descemet membrane (DM) detachment in failed deep anterior lamellar keratoplasty (DALK) and to report the outcome of Descemet membrane endothelial keratoplasty (DMEK) in a series of patients with DALK failure.
In this retrospective case series of patients who underwent DMEK for failed DALK at Toronto Western Hospital, 4 patients with failed DALK who underwent DMEK surgery were included. In all 4 cases, big bubble formation during initial DALK surgery had failed and the surgical technique was converted to manual dissection using the Melles technique. In 2 cases, the descemetorhexis in DMEK surgery was performed manually, and in 2 cases, the descemetorhexis was performed with the assistance of the femtosecond laser.
Four eyes of 4 patients aged 70 ± 4 years were included. Average follow-up time was 9 ± 5 months. Indications for DALK surgery were corneal dystrophy in 2 patients and corneal scars in the other 2. DALK failure was due to persistent DM detachment that created a double chamber in 2 patients and due to posterior lamellar haze in the other 2. After DMEK surgery, 2 patients had graft detachment and required rebubbling. In 1 patient, the DMEK scroll was attached after 1 rebubble attempt, and in the other patient, a second rebubble attempt was needed. The final visual acuities were 20/40, 20/50, 20/70, and 20/200 (because of dense cataract). All procedures were uneventful.
DMEK surgery may be effective in managing DALK failure.
提出一种针对深层前板层角膜移植术（DALK）失败后后囊膜混浊或持续性后弹力层（DM）脱离的新手术方法，并报告一系列DALK失败患者接受后弹力层内皮角膜移植术（DMEK）的结果。
在多伦多西部医院对因DALK失败而接受DMEK治疗的患者进行的这项回顾性病例系列研究中，纳入了4例因DALK失败而接受DMEK手术的患者。在所有4例病例中，初次DALK手术期间大泡形成失败，手术技术转为使用梅勒斯技术进行手动剥离。2例患者在DMEK手术中手动进行后弹力层撕除，2例患者在飞秒激光辅助下进行后弹力层撕除。
纳入了4例年龄为70±4岁患者的4只眼。平均随访时间为9±5个月。DALK手术的适应证为2例角膜营养不良和另外2例角膜瘢痕。DALK失败的原因是2例患者持续性DM脱离形成双腔，另外2例是后板层混浊。DMEK手术后，2例患者发生植片脱离，需要再次注气。1例患者在一次再次注气尝试后DMEK卷片附着，另1例患者需要进行第二次再次注气尝试。最终视力分别为20/40、20/50、20/70和20/200（因白内障致密）。所有手术均顺利。
DMEK手术可能有效治疗DALK失败。
