Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Cornea. 2019 Aug;38(8):976-979. doi: 10.1097/ICO.0000000000002000.
To describe the clinical outcomes of using C3F8 as a tamponade agent for the attachment of partially detached Descemet membrane endothelial keratoplasty (DMEK) grafts after failure of previous rebubbling attempts.
Interventional case series. We reviewed the medical records of all DMEK surgeries performed at Rabin Medical Center (Petach Tikva, Israel) between January 2016 and December 2018 in which 10% C3F8 tamponade was used for graft reattachments. Patient demographic details, indication for surgery, early postoperative endothelial cell loss, postoperative visual acuity, intraoperative and postoperative complications as well as graft survival were noted.
Five patients were included in this case series. Indications for DMEK were pseudophakic bullous keratopathy (n = 3), failed penetrating graft (n = 1), and Fuchs endothelial dystrophy (n = 1). In 4 of 5 cases, SF6 tamponade was used at the end of the initial DMEK surgery. In 1 case, air tamponade was used. In all cases, partial graft detachment was seen 1 to 2 weeks postoperatively, and anterior chamber rebubbling was performed using 20% SF6 gas. A second C3F8-assisted rebubbling was performed 10 to 70 days after the primary DMEK surgery. In all cases, complete graft attachment was achieved, and the corneas cleared. Early endothelial cell loss rates averaged at 44% ± 26% (range 20%-74%). One case which had a previous trabeculectomy with chronic preoperative and postoperative hypotony had failed 6 months after surgery. All the other grafts were clear at last visit.
Tamponade using nonexpansile 10% C3F8 gas can attach partially detached DMEK grafts after the failure of previous air- or SF6-assisted rebubbling attempts.
描述在先前的吹入尝试失败后，使用 C3F8 作为部分脱离的 Descemet 膜内皮角膜移植（DMEK）移植物的填塞剂以获得临床结果。
介入性病例系列研究。我们回顾了 2016 年 1 月至 2018 年 12 月期间在拉宾医疗中心（以色列佩塔提克瓦）进行的所有 DMEK 手术的病历，其中 10％C3F8 作为填塞剂用于重新固定移植物。记录患者的人口统计学资料、手术适应证、术后早期内皮细胞丢失、术后视力、术中及术后并发症以及移植物存活率。
本病例系列研究共纳入 5 例患者。DMEK 的适应证为假性晶状体囊泡性角膜病变（n = 3）、穿透性移植失败（n = 1）和 Fuchs 内皮营养不良（n = 1）。在 5 例患者中，有 4 例在初始 DMEK 手术后使用 SF6 进行了填塞，有 1 例使用空气进行了填塞。所有病例均在术后 1 至 2 周内出现部分移植物脱离，使用 20％SF6 气体进行前房再吹入。初次 DMEK 手术后 10 至 70 天进行了第二次 C3F8 辅助再吹入。所有病例均成功实现了完全的移植物附着，角膜恢复透明。早期内皮细胞丢失率平均为 44％±26％（范围为 20％至 74％）。1 例先前进行过小梁切除术并伴有慢性术前和术后低眼压的患者在手术后 6 个月时失败。所有其他移植物在最后一次就诊时均清晰。
在先前的空气或 SF6 辅助再吹入尝试失败后，使用非膨胀性 10％C3F8 气体填塞可以固定部分脱离的 DMEK 移植物。
