Helaiwa Khaled, Januschowski Kai, Boden Karl T, Rickmann Annekatrin
Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany.
Centre for Ophthalmology, Eberhard-Karls-University Tübingen, Tübingen, Germany.
Case Rep Ophthalmol. 2018 Aug 22;9(2):381-387. doi: 10.1159/000492173. eCollection 2018 May-Aug.
The aim of this article is to report an unusual case of postoperative graft loss into the vitreous cavity after Descemet membrane endothelial keratoplasty (DMEK) in a patient with an unstable iris-lens diaphragm (scleral-fixated intraocular lens [sf-IOL]) and its successful retrieval with a favourable outcome.
This is a retrospective case report.
DMEK procedure was performed in a vitrectomized eye of an 80-year-old woman with pre-existing sf-IOL due to pseudophakic bullous keratopathy. In the setting of an inadvertently created oversized Ando iridectomy and unstable iris-lens diaphragm due to sf-IOL, repeated loss of an anterior chamber gas tamponade occurred. At the 3rd postoperative day, the patient noticed a change in visual perception, and we could detect a loss of the graft into the vitreous via B-scan ultrasound. A 23-G vitrectomy was performed promptly to recover the graft using a bimanual hand-over-hand technique. Six months after DMEK, the patient had a clear cornea without dehiscences with a central corneal thickness of 533 µm and endothelial cell count of 1,219 cells/mm.
This case demonstrates the possibility of graft recovery from the vitreous after DMEK and subsequent corneal clearing despite unstable iris-lens diaphragm and vitrectomized eye.
本文旨在报告一例不寻常的病例，该病例为一名虹膜 - 晶状体隔膜不稳定（巩膜固定人工晶状体[sf - IOL]）的患者在进行Descemet膜内皮角膜移植术（DMEK）后移植物掉入玻璃体腔，以及成功取出移植物并获得良好预后的情况。
这是一篇回顾性病例报告。
一名80岁女性因人工晶状体性大泡性角膜病变，在已行玻璃体切除术且植入sf - IOL的眼中进行了DMEK手术。由于无意中形成的过大的安藤虹膜切除术以及sf - IOL导致的虹膜 - 晶状体隔膜不稳定，前房气体填塞反复丢失。术后第3天，患者注意到视觉感知发生变化，通过B超超声我们检测到移植物掉入玻璃体。立即进行了23G玻璃体切除术，采用双手交替技术取出移植物。DMEK术后6个月，患者角膜清晰，无裂开，中央角膜厚度为533 µm，内皮细胞计数为1219个细胞/mm²。
该病例表明，尽管存在虹膜 - 晶状体隔膜不稳定和玻璃体切除的眼睛，但DMEK术后仍有可能从玻璃体中恢复移植物并随后使角膜变清。
