Mimouni Michael, Kronschläger Martin, Ruiss Manuel, Findl Oliver
Department of Ophthalmology, Rambam Health Care Campus, Haifa affiliated with the Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
BMC Ophthalmol. 2021 Apr 15;21(1):180. doi: 10.1186/s12886-021-01934-2.
Remnant interface fluid following Descemet stripping automated endothelial keratoplasty (DSAEK) is associated with postoperative detachments. The aim of this study was to assess outcomes of intraoperative optical coherence tomography (iOCT) guided meticulous peripheral corneal sweeping for removal of interface fluid during ultra-thin (UT) DSAEK.
This retrospective study included all eyes underwent iOCT guided UT-DSAEK from October 2016 to February 2018 at the Hanusch Hospital, Vienna, Austria. Peripheral meticulous corneal sweeping was performed to remove excess fluid. Central graft thickness (CGT) was measured prior to surgery, after graft bubbling and after corneal sweeping. Remnant interface fluid rates were compared between eyes that underwent rebubbling and those that did not.
Overall, 28 eyes of 28 patients with a mean age of 73.9 ± 10.0 years were included. An iOCT guided meticulous peripheral sweeping was performed in 89.3% (n = 25) of the cases. Following 84% (n = 21) of the peripheral sweeping performed, remnant fluid was no longer identified. Following peripheral sweeping the interface fluid height was reduced from 17.31 ± 15.96 μm to 3.46 ± 9.52 μm (p < 0.001) and CGT was reduced by 7% (p < 0.001). Rebubbling was performed in 17.9% (n = 5) of the cases. The rebubbling group had a greater proportion of patients that had remnant fluid identified with iOCT at the end of surgery despite meticulous peripheral sweeping (60.0% versus 4.4%, p = 0.01).
The iOCT identified subclinical remnant fluid in nearly 90% of UT-DSAEK cases. An iOCT guided peripheral corneal sweeping led to resolution of interface fluid in a majority of cases. Eyes with persistent remnant fluid despite peripheral corneal sweeping are more likely to require subsequent rebubbling.
在Descemet膜剥除自动内皮角膜移植术（DSAEK）后，残留的界面液体会导致术后角膜瓣脱离。本研究的目的是评估术中光学相干断层扫描（iOCT）引导下在超薄（UT）DSAEK手术中进行细致的周边角膜清扫以去除界面液体的效果。
这项回顾性研究纳入了2016年10月至2018年2月在奥地利维也纳哈努施医院接受iOCT引导的UT-DSAEK手术的所有患眼。进行周边细致的角膜清扫以去除多余的液体。在手术前、植片形成水泡后和角膜清扫后测量中央植片厚度（CGT）。比较进行再次气泡形成的患眼和未进行再次气泡形成的患眼之间的残留界面液率。
总体而言，纳入了28例患者的28只患眼，平均年龄为73.9±10.0岁。89.3%（n = 25）的病例进行了iOCT引导下的周边细致清扫。在84%（n = 21）的周边清扫后，未再发现残留液体。周边清扫后，界面液体高度从17.31±15.96μm降至至3.46±9.52μm（p < 0.001），CGT降低了7%（p < 0.001）。17.9%（n = 5）的病例进行了再次气泡形成。再次气泡形成组中，尽管进行了细致的周边清扫，但在手术结束时通过iOCT发现仍有残留液体的患者比例更高（60.0%对4.4%，p = 0.01）。
iOCT在近90%的UT-DSAEK病例中发现了亚临床残留液体。iOCT引导下的周边角膜清扫在大多数病例中可使界面液体得到解决。尽管进行了周边角膜清扫但仍有持续残留液体的患眼更有可能需要随后的再次气泡形成。
