Al-Romaih Arwa Z, Al-Jindan Mohanna Y, Al-Johani Saud M
Department of Ophthalmology, King Abdulaziz University Hospital, Riyadh, Saudi Arabia.
Department of Ophthalmology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Saudi J Med Med Sci. 2019 Sep-Dec;7(3):179-182. doi: 10.4103/sjmms.sjmms_19_18. Epub 2019 Aug 28.
In an aphakic eye with corneal edema, performing Descemet's stripping automated endothelial keratoplasty (DSAEK) combined with implantation of intraocular lens can be a challenge. This case report describes a surgical technique for postsurgical aphakia with endothelial decompensation in a 42-year-old female with Marfan syndrome and subluxated lens. This technique comprised implanting DSAEK with fibrin glue-assisted sutureless posterior chamber intraocular lens. The donor lenticels were formed on a 60-kHz femtosecond laser platform (IntraLase). Two partial-thickness scleral flaps and sclerotomies were created, and then, the Descemet's membrane was scored and stripped. A posterior chamber intraocular lens was implanted, and its haptics was pulled out through the sclerotomies and tucked beneath the flaps. The flaps were then apposed with fibrin glue. The donor lenticule was introduced to the anterior chamber and unfolded. Air tamponade was used to stabilize and center it. This technique significantly improved the uncorrected and best-corrected visual acuities of the patient, and no donor dislocations were reported. This case corroborates the findings of few similar cases that have found combined use of glued intraocular lens with DSAEK to be beneficial in such cases.
在一只患有角膜水肿的无晶状体眼中，进行Descemet膜剥脱自动内皮角膜移植术（DSAEK）并植入人工晶状体可能具有挑战性。本病例报告描述了一名患有马凡综合征且晶状体半脱位的42岁女性，针对术后无晶状体且伴有内皮失代偿的一种手术技术。该技术包括植入DSAEK并使用纤维蛋白胶辅助无缝合后房型人工晶状体。供体角膜内皮细胞片在60kHz飞秒激光平台（IntraLase）上制备。制作两个部分厚度的巩膜瓣和巩膜切口，然后对Descemet膜进行划痕并剥离。植入后房型人工晶状体，其襻通过巩膜切口拉出并折叠在瓣膜下方。然后用纤维蛋白胶使瓣膜贴合。将供体角膜内皮细胞片引入前房并展开。使用空气填塞使其稳定并居中。该技术显著改善了患者的未矫正和最佳矫正视力，且未报告供体脱位情况。本病例证实了少数类似病例的研究结果，即在这类病例中，将胶合人工晶状体与DSAEK联合使用是有益的。
