Koo Ellen H
Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, 900 NW 17th St, Miami, FL 33136, FL, USA.
Am J Ophthalmol Case Rep. 2019 Jun 13;15:100497. doi: 10.1016/j.ajoc.2019.100497. eCollection 2019 Sep.
This paper describes a modified technique for the Descemet's Stripping Automated Endothelial Keratopasty (DSAEK) surgery in eyes with abnormal or altered anatomy. Certain anatomic abnormalities increase the level of surgical complexity, and lead to increased risk of donor lenticule detachment. These challenges include aniridia, abnormal iris, aphakia and hypotony from previous vitrectomy.
The Sheets glide was trimmed to 4mm in width and inserted into the clear-corneal wound. The "needle-push"/Fichman glide technique was used to insert the DSAEK donor graft. The modification of the technique involves maintaining the Sheets glide in the eye for the duration of the intraoperative air bubble. After confirming desired orientation of the graft, air was injected into the anterior chamber, creating a large air bubble between the graft and the Sheets glide. After 10 minutes, the Sheets glide was removed, and the main wound was closed.
This technique overcomes the challenges of posterior air bubble migration and posterior dislocation of the donor lenticule in eyes with altered anatomy.
本文描述了一种用于解剖结构异常或改变的眼睛的改良Descemet膜剥脱自动内皮角膜移植术（DSAEK）技术。某些解剖异常会增加手术复杂性，并导致供体晶状体瓣脱离的风险增加。这些挑战包括无虹膜、虹膜异常、无晶状体以及既往玻璃体切除术后的低眼压。
将Sheets滑瓣修剪至4毫米宽，并插入透明角膜伤口。采用“针推”/菲克曼滑瓣技术插入DSAEK供体移植物。该技术的改良包括在术中气泡持续期间将Sheets滑瓣保留在眼内。在确认移植物的理想方向后，向前房注入空气，在移植物和Sheets滑瓣之间形成一个大气泡。10分钟后，取出Sheets滑瓣，并关闭主伤口。
该技术克服了解剖结构改变的眼睛中后气泡迁移和供体晶状体瓣后脱位的挑战。
