From the Virginia Eye Consultants (CVP), Norfolk, VA; Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA.
Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA.
Can J Ophthalmol. 2020 Dec;55(6):509-517. doi: 10.1016/j.jcjo.2020.06.012. Epub 2020 Jul 27.
To describe a new/modified technique to manage posterior vitreous pressure (PVP) during penetrating keratoplasty (PKP) and report a small series.
Retrospective interventional case series and technique description.
PKP eyes necessitating mattress suture placement owing to PVP.
Retrospective chart review from 2016 to 2019 was undertaken. Placed prophylactically (before trephination) or after trephination, the mattress suture is placed limbus-to-limbus across the anterior chamber. A second mattress suture can be placed in the opposite meridian (perpendicularly) for added support (safety basket configuration). Variations of suture technique are described based on lens status (i.e., phakic, pseudophakic, aphakic) and intraoperative timing. Parameters assessed included demographics, lens status, suture indications, intraoperative technique details, successful PKP completion, and presence of primary failure.
There were 6 phakic eyes (5 patients) and 9 pseudophakic/aphakic eyes (8 patients). Indications for the phakic subgroup were obesity (83%), poor scleral rigidity (83%), repeated iris prolapse (67%), dense mature cataract (33%), and planned large-diameter PKP (33%). Indications for pseudophakic/aphakic eyes included intraocular lens/iris prolapse (100%), pre-existing iris defects (67%), and planned large-diameter PKP (33%). Successful PKP was performed in all cases. Whereas one case had residual corneal edema in the setting of a persistent epithelial defect owing to limbal stem cell deficiency, all other cases demonstrated no primary graft failure.
Although increased PVP can present a stressful and challenging situation, it is important to have multiple options for management. This simple mattress suture technique normalizes the lens-iris complex behaviour and appears safe for the donor graft.
描述一种新的/改良的技术，以管理穿透性角膜移植术（PKP）中的后玻璃体压力（PVP），并报告一个小系列。
回顾性介入病例系列和技术描述。
由于 PVP 需要行褥式缝线固定的 PKP 眼。
回顾 2016 年至 2019 年的病历。预防性放置（在环钻前）或环钻后，褥式缝线在虹膜前房内呈环形跨越角膜缘。可在对侧子午线（垂直）放置第二条褥式缝线以增加支撑（安全篮结构）。根据晶状体状态（即，晶状体透明、假性晶状体透明、无晶状体）和术中时机描述缝线技术的变化。评估的参数包括人口统计学、晶状体状态、缝线适应证、术中技术细节、成功完成 PKP 以及原发性失败的发生。
有 6 只（5 例）晶状体透明眼和 9 只（8 例）假性晶状体透明/无晶状体眼。晶状体透明亚组的适应证包括肥胖（83%）、巩膜刚性差（83%）、反复虹膜脱出（67%）、致密成熟白内障（33%）和计划大直径 PKP（33%）。假性晶状体透明/无晶状体眼的适应证包括人工晶状体/虹膜脱出（100%）、预先存在的虹膜缺损（67%）和计划大直径 PKP（33%）。所有病例均成功完成 PKP。虽然一例由于边缘干细胞缺乏导致持续性上皮缺损而存在残余角膜水肿，但所有其他病例均未出现原发性移植物失败。
尽管 PVP 增加可能会带来紧张和挑战，但重要的是要有多种管理选择。这种简单的褥式缝线技术可使晶状体-虹膜复合体的行为正常化，对供体移植物似乎是安全的。
