Benage Matthew, Korchak Michael, Boyce Michelle, Mayko Zachary M, Bauer Alex, Straiko Michael D, Terry Mark A, Sáles Christopher S, Greiner Mark A
Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Department of Ophthalmology, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, MD, USA.
Am J Ophthalmol Case Rep. 2020 Apr 3;18:100686. doi: 10.1016/j.ajoc.2020.100686. eCollection 2020 Jun.
To describe Descemet membrane endothelial keratoplasty (DMEK) cases complicated by spontaneous intraoperative fibrin formation.
DMEK surgeries performed at two centers using a standardized technique were reviewed retrospectively for the occurrence of intraoperative fibrin formation. Cases were assessed for recipient medical history, donor age, best spectacle-corrected visual acuity (BSCVA), intraoperative unscrolling time, 6-month endothelial cell loss (ECL), and the course of the mate donor cornea.
In this review of 868 cases of standardized DMEK surgery with surgical peripheral iridotomy, 32 eyes of 29 patients (3.7%) were complicated by the formation of intraoperative fibrin formation, including 3 patients that developed fibrin in both eyes. Three of the 32 grafts failed (9.4%). None of the mate corneas transplanted (n = 27) developed complications related to fibrin. The donor age ranged from 51 to 75 years and recipient age ranged from 49 to 82 years (median, 66 years). Unscrolling time ranged from 1 to 105 min (median, 15 min). Nine eyes required one rebubble procedure. No eyes had vision-limiting comorbidities, and the 6-month BSCVA was ≥20/40 in all eyes. Six-month ECL ranged from 19% to 73% (median, 44%).
We conclude that fibrin formation during DMEK surgery is an uncommon but important complication that can make graft manipulation more difficult, and may have deleterious effects on endothelial cell density and graft survival.
描述合并术中自发性纤维蛋白形成的Descemet膜内皮角膜移植术（DMEK）病例。
回顾性分析在两个中心采用标准化技术进行的DMEK手术中术中纤维蛋白形成的发生情况。评估病例的受者病史、供体年龄、最佳矫正视力（BSCVA）、术中展开时间、6个月时的内皮细胞丢失率（ECL）以及配对供体角膜的情况。
在本次对868例采用手术周边虹膜切开术的标准化DMEK手术的回顾中，29例患者的32只眼（3.7%）出现术中纤维蛋白形成，其中3例患者双眼出现纤维蛋白。32片移植物中有3片失败（9.4%）。移植的配对角膜（n = 27）均未出现与纤维蛋白相关的并发症。供体年龄范围为51至75岁，受者年龄范围为49至82岁（中位数为66岁）。展开时间范围为1至105分钟（中位数为15分钟）。9只眼需要进行一次再注气操作。所有眼均无限制视力的合并症，所有眼6个月时的BSCVA≥20/40。6个月时的ECL范围为19%至73%（中位数为44%）。
我们得出结论，DMEK手术期间纤维蛋白形成是一种罕见但重要的并发症，可使移植物操作更加困难，并可能对内皮细胞密度和移植物存活产生有害影响。
