Tourkmani Abdo Karim, Turnbull Andrew M J, Hossain Parwez N, Konstantopoulos Aristides, Anderson David F
Cornea and External Eye Disease Service, Department of Ophthalmology, University Hospital Southampton, Southampton SO16 6YD, UK.
Int J Ophthalmol. 2020 Feb 18;13(2):342-345. doi: 10.18240/ijo.2020.02.19. eCollection 2020.
To describe a modified technique of donor lenticule dissection for thin manual Descemet stripping endothelial keratoplasty (TM-DSEK).
Donor material was soaked in balanced salt solution (BSS) for 30min, before being mounted on an artificial anterior chamber (AAC). Rather than BSS, the AAC was filled with filtered air, resulting in a visible reflection at the corneal endothelium-air interface. This reflection served as a landmark for the depth of the dissection, facilitating the creation of a thin lenticule with low risk of perforation. Dissection was commenced at a standardized depth of 500 microns, with no initial pachymetry necessary. Totally 29 donor corneas were dissected by a novice TM-DSEK surgeon. Dissection time, central graft thickness at 2mo and complications were analysed.
Results were similar to other endothelial keratoplasty techniques, despite the cases being performed by a novice DSEK surgeon. Mean dissection time was 7min (range 6-10). One graft perforation occurred (3.45%), but the air tamponaded the break and enabled dissection to be restarted and completed from a different location. Mean central graft thickness after at least two months follow-up was 106 microns (range 25-170).
A problem with manual DSEK is the risk of graft perforation by attempting to dissect too thin a lenticule, or creating a thick graft due to fear of perforating. This modified air-guided technique addresses this problem, and is recommended for surgeons either embarking on the learning curve, or who wish to achieve more consistently thin grafts while reducing perforation rates.
描述一种改良的供体植片剥离技术，用于超薄手动角膜后弹力层剥除内皮角膜移植术（TM-DSEK）。
将供体材料浸泡在平衡盐溶液（BSS）中30分钟，然后安装在人工前房（AAC）上。AAC中填充的不是BSS，而是过滤空气，这在角膜内皮-空气界面产生了可见的反射。该反射作为剥离深度的标志，有助于制作穿孔风险低的超薄植片。在标准化深度500微米处开始剥离，无需初始测厚。一名初涉TM-DSEK的外科医生共对29个供体角膜进行了剥离。分析了剥离时间、术后2个月的中央植片厚度及并发症。
尽管这些病例由一名初涉DSEK的外科医生操作，但结果与其他内皮角膜移植技术相似。平均剥离时间为7分钟（范围6-10分钟）。发生了1例植片穿孔（3.45%），但空气填塞了破口，使剥离能够从不同位置重新开始并完成。至少随访2个月后的平均中央植片厚度为106微米（范围25-170微米）。
手动DSEK的一个问题是，试图剥离过薄的植片或因担心穿孔而制作出厚植片时存在植片穿孔风险。这种改良的空气引导技术解决了这个问题，推荐给刚开始学习该技术的外科医生，或希望在降低穿孔率的同时更稳定地获得超薄植片的外科医生。
