Oganesyan Oganes G, Neroev Vladimir V, Grdikanyan Arthur A, Getadaryan Vostan R
Department of Cornea Surgery, Helmholtz Moscow Institute of Eye Diseases, Moscow, Russia.
Cornea. 2018 May;37(5):667-671. doi: 10.1097/ICO.0000000000001551.
To describe the feasibility of same-day, consecutive use of a single donor cornea in 5 patients with corneal pathology, who required anterior lamellar and endothelial keratoplasties.
Descemet membrane (DM) with endothelium was completely stripped from a single corneoscleral button and punched out from the endothelial side with a circular, standard punch. Using a custom-made punch for linear cutting of DM, we obtained 4 quarter-grafts (Q-graft). The denuded and punched-out corneal stroma was transplanted in 1 patient with keratoconus, using the big-bubble deep anterior lamellar keratoplasty (DALK) technique. The 4 DM Q-grafts were consecutively transplanted to 4 patients with Fuchs dystrophy using the quarter Descemet membrane endothelial keratoplasty (Q-DMEK or 1/4 DMEK) technique.
All surgical procedures were performed successfully during 1 surgical session. No intraoperative or postoperative complications requiring intervention were observed. Six months after surgery, the decimal best-corrected visual acuity achieved was 0.66 after DALK and 0.95 ± 0.1 (range, 0.8-1.0) in the 4 Q-DMEK cases; the endothelial cell density was 1680 ± 254 cells/mm (range, 1492-2039 cells/mm). Six months postoperatively, all corneas were clear.
In this limited series, we demonstrate that 1 donor cornea can be successfully used for 5 recipients. Although performing DALK and Q-DMEK on a single day is technically challenging, it is feasible and can dramatically reduce the shortage and the cost of corneal tissue. Strict case selection is necessary. Further study on this approach is required.
描述在5例患有角膜病变且需要进行前板层角膜移植术和内皮角膜移植术的患者中，同一天连续使用单个供体角膜的可行性。
将带有内皮的Descemet膜（DM）从单个角膜缘植片上完全剥离，并使用圆形标准冲切器从内皮侧冲出。使用定制的用于线性切割DM的冲切器，我们获得了4个四分之一植片（Q-植片）。将剥脱并冲出的角膜基质使用大泡深前板层角膜移植术（DALK）技术移植到1例圆锥角膜患者中。将4个DM Q-植片使用四分之一Descemet膜内皮角膜移植术（Q-DMEK或1/4 DMEK）技术连续移植到4例Fuchs角膜内皮营养不良患者中。
所有手术均在1次手术过程中成功完成。未观察到需要干预的术中或术后并发症。术后6个月，DALK术后的小数最佳矫正视力达到0.66，4例Q-DMEK病例的小数最佳矫正视力为0.95±0.1（范围为0.8 - 1.0）；内皮细胞密度为1680±254个细胞/mm²（范围为1492 - 2039个细胞/mm²）。术后6个月，所有角膜均保持透明。
在这个有限的系列研究中，我们证明1个供体角膜可以成功用于5名接受者。虽然在同一天进行DALK和Q-DMEK在技术上具有挑战性，但它是可行的，并且可以显著减少角膜组织的短缺和成本。严格的病例选择是必要的。需要对这种方法进行进一步研究。
