Department of Neuroscience, Psychology, Pharmacology and Child Health, Eye Clinic, University of Florence, Florence, Italy.
Eur J Ophthalmol. 2022 Jan;32(1):NP47-NP50. doi: 10.1177/1120672120973610. Epub 2020 Nov 20.
To present a case of double anterior chamber after DALK and its surgical management.
A 67-year-old healthy woman underwent deep anterior lamellar keratoplasty (DALK) in her right eye for keratoconus with the big-bubble technique. About 7 days after surgery a partial detachment of the Descemet membrane from the posterior corneal stroma was revealed using AS-OCT (double anterior chamber appearance). In spite of two injections in the anterior chamber of air and gas on the 7th and 9th post-operative days respectively, the double anterior chamber still persisted. Furthermore, both air and gas passed through the little perforation of the host Descemet membrane-endothelium complex and enlarged the space between the stroma and Descemet membrane. About 10 weeks after DALK, a spontaneous resolution of the double anterior chamber was observed.
This case suggests that an injection of air or gas into the anterior chamber, to deal with a Descemet membrane detachment following perforation during DALK procedure, can enlarge the double anterior chamber by increasing the space between stroma and Descemet membrane. These cases can be managed with a "wait and see" strategy for a spontaneous resolution to Descemet membrane detachment.
介绍一例 DALK 术后双前房的病例及其手术处理。
一名 67 岁健康女性因圆锥角膜接受了深板层角膜移植术（DALK），术中采用大泡技术。术后约 7 天，应用 AS-OCT 检查发现后弹力层从角膜基质部分脱离（双前房外观）。尽管分别在术后第 7 天和第 9 天在前房内注入了 2 次空气和气体，但双前房仍持续存在。此外，空气和气体均穿过宿主后弹力层-内皮复合体的小穿孔，并扩大了基质与后弹力层之间的空间。DALK 术后约 10 周，观察到双前房自发缓解。
本病例提示，对于 DALK 术中后弹力层穿孔导致的后弹力层脱离，在前房内注入空气或气体可通过增加基质与后弹力层之间的空间来扩大双前房。这些病例可采用“静观其变”的策略，等待后弹力层脱离的自发缓解。
