Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Cornea. 2020 Dec;39(12):1499-1502. doi: 10.1097/ICO.0000000000002369.
To describe the clinical characteristics and treatment of spontaneous Descemet membrane (DM) detachment occurring decades after penetrating keratoplasty (PK).
A multicenter interventional case series design was used. We reviewed the medical records of 4 patients with a history of PK presenting with spontaneous DM detachment at 3 university hospitals in Israel and an ocular surgery institute in The Netherlands in 2016 to 2019. Patient demographic and clinical data, postoperative best corrected visual acuity, findings on preoperative and postoperative anterior segment optical coherence tomography (AS-OCT), and graft survival were recorded.
Patients were aged 46 to 50 years. All had undergone PK for keratoconus 20 to 26 years previously. Patients presented within 18 to 180 days of onset of visual disturbance. Symptoms included sudden painless visual loss (2 patients), gradual visual loss and foreign body sensation (1 patients), and visual loss not otherwise specified (1 patient). Slit-lamp examination showed corneal edema, and AS-OCT showed DM detachment of variable extent. In 2 patients, the initial diagnosis was graft rejection and failure. Treatment consisted of anterior chamber injection of air (n = 3) or 20% SF6 (n = 1). In 3 patients, the DM reattached and the cornea regained its clarity. The fourth patient had persistent DM detachment that required repeated PK.
Spontaneous DM detachment can mimic late graft failure in patients after PK. If diagnosed early, DM reattachment may be performed by air/gas injection, avoiding repeated keratoplasty. Eyes with presumed late penetrating graft rejection or failure should be examined by AS-OCT to exclude DM detachment.
描述穿透性角膜移植（PK）后数十年发生的自发性后弹力膜（Descemet membrane，DM）脱离的临床特征和治疗方法。
采用多中心干预性病例系列设计。我们回顾了 2016 年至 2019 年期间，以色列 3 家大学医院和荷兰一家眼科手术研究所的 4 例有 PK 史且出现自发性 DM 脱离的患者的病历。记录患者的人口统计学和临床数据、术后最佳矫正视力、术前和术后眼前节光学相干断层扫描（anterior segment optical coherence tomography，AS-OCT）的发现以及移植物的存活率。
患者年龄为 46 岁至 50 岁。所有人均因圆锥角膜于 20 至 26 年前接受 PK。患者在出现视觉障碍后 18 天至 180 天内就诊。症状包括突发无痛性视力丧失（2 例）、逐渐视力丧失和异物感（1 例）以及无法明确原因的视力丧失（1 例）。裂隙灯检查显示角膜水肿，AS-OCT 显示 DM 脱离程度不一。在 2 例患者中，最初的诊断是移植物排斥和失败。治疗方法包括前房内注射空气（n = 3）或 20%SF6（n = 1）。在 3 例患者中，DM 重新附着，角膜恢复透明。第 4 例患者持续性 DM 脱离，需要反复进行 PK。
自发性 DM 脱离可模仿 PK 后患者的晚期移植物失败。如果早期诊断，DM 重新附着可通过空气/气体注射来实现，从而避免反复进行角膜移植。疑似晚期穿透性移植排斥或失败的眼睛应通过 AS-OCT 检查以排除 DM 脱离。
