Oftalmico di Torino, Struttura Complessa Oculistica 2, Turin, Italy.
Ospedale San Giovanni Bosco, Struttura Complessa Oculistica 2, Turin, Italy.
Eur J Ophthalmol. 2021 Mar;31(2):774-777. doi: 10.1177/1120672120932108. Epub 2020 Jun 3.
The aim of this study was to describe a surgical technique to perform deep anterior lamellar keratoplasty (DALK) despite inadvertent full thickness trephination in one quadrant.
Case report of a 19-year-old boy who underwent DALK for visually significant post-infectious stromal scar in his left eye. An unintentional full thickness trephination occurred in the upper-nasal quadrant at the beginning of the surgery. After suturing the perforated area, manual DALK was performed, and an air bubble was left in the anterior chamber. Evaluated outcomes included best spectacle corrected visual acuity (BSCVA), residual recipient bed thickness, endothelial cell count (ECC), graft clarity, rejection, and presence/absence of double anterior chamber.
The surgery was completed without any further complications. No double anterior chamber or Urrets-Zavalia syndrome was observed on the first postoperative day. Mean residual recipient bed thickness was 72 μm and regular. ECC was 2446 cell/mm. BSCVA at 18 months of follow-up was 0.9. There were no episodes of rejection, and the graft remained clear at the last follow-up (4 years).
Inadvertent partial full thickness trephination of the recipient cornea is a largely preventable but possible complication during DALK. Penetrating keratoplasty conversion can be avoided by performing a manual dissection DALK.
本研究旨在描述一种在一个象限发生全层角膜环钻术（DALK）的情况下进行深层前板层角膜移植（DALK）的手术技术。
报告一例 19 岁男孩，左眼因感染后基质瘢痕而接受 DALK 治疗。手术开始时，上鼻象限无意中发生全层环钻术。穿孔区域缝合后，进行手动 DALK，并在前房内留下气泡。评估结果包括最佳矫正视力（BSCVA）、受体床残余厚度、内皮细胞计数（ECC）、移植物清晰度、排斥反应以及是否存在双前房。
手术顺利完成，无进一步并发症。术后第一天未观察到双前房或 Urrets-Zavalia 综合征。平均受体床残余厚度为 72μm，规则。ECC 为 2446 个细胞/mm。18 个月随访时 BSCVA 为 0.9。无排斥反应发生，最后一次随访（4 年）时移植物仍清晰。
在 DALK 过程中，受体角膜的意外部分全层环钻术是一种可以预防但可能发生的并发症。通过进行手动分离 DALK，可以避免穿透性角膜移植术的转换。
