Mariacher Siegfried, Mariacher Martina, Boden Karl Thomas, Szurman Peter, Januschowski Kai
Knappschaft Eye Clinic, Knappschaft Hospital Saar GmbH, An der Klinik 10, 66280, Sulzbach, Germany.
Centre for Ophthalmology, University Eye Hospital Tuebingen, Schleichstr. 12, 72076, Tuebingen, Germany.
BMC Ophthalmol. 2019 Jul 29;19(1):163. doi: 10.1186/s12886-019-1181-3.
Clinical outcome after successful reorientation of an upside-down implanted DMEK (Descemet Membrane Endothelial Keratoplasty) graft 4 weeks after initial transplantation.
A 71-year-old woman presented with Fuchs' endothelial corneal dystrophy for DMEK. After initial DMEK the donor graft was fully attached and well centred during intracameral gas filling. When the gas bubble was fully resorbed the graft started to detach. Therefore, two intracameral gas injections were consecutively performed. During the second re-bubbling, an upside-down orientation was observed and so the graft was flipped, centred, re-attached and finally stabilized by an intracameral gas bubble. Three weeks after reorientation slit lamp examinations showed a well centred and attached graft, endothelial cells that started functioning and a patient's visual acuity of 20/40. Visual acuity increased to a 20/32 vision in the observed eye three months later and further improved to 20/20 6 months after reorientation and stayed stable between 20/32 and 20/20 during the remaining 15 months of follow-up, with a clear and well-attached graft.
Reorientation of an upside down DMEK graft was successful even 4 weeks after initial DMEK. Visual recovery and endothelial cell count increase were stepwise noticed during the first 6 months and 15 months after reorientation, respectively. Finally a favourable outcome with 20/32 to 20/20 vision at least 6 months after graft reorientation was achieved. Therefore, restoring full graft function could last several weeks or even months following (late) reorientation of an upside-down DMEK graft.
初次移植4周后倒置植入的Descemet膜内皮角膜移植术（DMEK）成功重新定位后的临床结果。
一名71岁女性因Fuchs内皮角膜营养不良接受DMEK手术。初次DMEK术后，供体移植物在房内注入气体时完全附着且居中。当气泡完全吸收后，移植物开始脱离。因此，连续进行了两次房内气体注射。在第二次重新注入气泡时，观察到移植物呈倒置方向，于是将移植物翻转、居中、重新附着，最后通过房内气泡使其稳定。重新定位三周后，裂隙灯检查显示移植物居中且附着良好，内皮细胞开始发挥功能，患者视力为20/40。三个月后，患眼视力提高到20/32，重新定位六个月后进一步提高到20/20，并在随后的15个月随访期间保持在20/32至20/20之间稳定，移植物清晰且附着良好。
即使在初次DMEK术后4周，倒置DMEK移植物的重新定位也是成功的。分别在重新定位后的前6个月和15个月观察到视力恢复和内皮细胞计数增加。最终，移植物重新定位至少6个月后，视力达到20/32至20/20的良好结果。因此，倒置DMEK移植物（晚期）重新定位后，恢复移植物的全部功能可能需要数周甚至数月。
