Hayashi Takahiko, Oyakawa Itaru, Matsuzawa Akiko, Yuda Kentaro, Shimizu Toshiki, Tsuchiya Ayako, Mizuki Nobuhisa, Kato Naoko
Department of Ophthalmology, Yokohama Minami Kyosai Hospital Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa Department of Ophthalmology, Heart Life Hospital Department of Ophthalmology, Ryukyu University, Okinawa Department of Ophthalmology, St. Marianna University School of Medicine Department of Ophthalmology, Kawasaki Municipal Tama Hospital, Kanagawa Department of Ophthalmology, Saitama Medical University, Saitama, Japan.
Medicine (Baltimore). 2018 Jun;97(26):e11245. doi: 10.1097/MD.0000000000011245.
Graft insertion into the anterior chamber is one of the most important procedures for successful Descemet membrane endothelial keratoplasty (DMEK). Especially in eyes with fragile zonular fibers and a shallow anterior chamber, smooth graft insertion tends to become more difficult. Ophthalmic viscoelastic devices (OVDs) can usually help to retain the space in the anterior chamber and to improve the safety of manipulations during various ophthalmic surgeries. Therefore, we postulated that graft insertion into the anterior chamber could be improved by their use. The purpose of this study is to investigate the availability and efficacy of OVDs during graft insertion in DMEK surgery.A total of 11 eyes of 9 patients with bullous keratopathy who underwent DMEK were retrospectively analyzed. The cause of bullous keratopathy was corneal endothelial decompensation following laser iridotomy in all eyes. We used low viscous dispersive OVD (Opegan) to maintain the anterior chamber depth during graft insertion in all of the eyes.The graft insertion was uneventful in all of the eyes. The inserted graft was attached to the back surface of the cornea. However, 2 eyes needed rebubbling, and after rebubbling, all of the 2 grafts completely attached to the back surface of the cornea. The best spectacle-corrected visual acuity significantly improved 6 months after surgery (P < .001) and the central corneal thickness significantly decreased (P < .001).The use of OVD facilitates safer graft insertion during DMEK, and subsequently prevents endothelial cell loss, which leads to a successful procedure.
植片植入前房是成功进行Descemet膜内皮角膜移植术（DMEK）的最重要步骤之一。特别是在晶状体悬韧带纤维脆弱且前房浅的眼中，顺利植入植片往往变得更加困难。眼科粘弹性装置（OVDs）通常有助于维持前房空间，并提高各种眼科手术操作的安全性。因此，我们推测使用OVDs可以改善植片植入前房的情况。本研究的目的是探讨在DMEK手术中植入植片时OVDs的可用性和有效性。
对9例大疱性角膜病变患者共11只眼行DMEK手术进行回顾性分析。所有眼大疱性角膜病变的病因均为激光虹膜切开术后角膜内皮失代偿。在所有眼中，我们使用低粘性分散性OVD（Opegan）在植入植片时维持前房深度。
所有眼中植片植入均顺利。植入的植片附着于角膜后表面。然而，2只眼需要再次注气，再次注气后，2只植片均完全附着于角膜后表面。术后6个月最佳矫正视力显著提高（P<0.001），中央角膜厚度显著降低（P<0.001）。
在DMEK手术中使用OVD有助于更安全地植入植片，随后防止内皮细胞丢失，从而使手术成功。
