Elahi Sina, Saad Alain, Gatinel Damien
Fondation Ophtalmologique Adolphe de Rothschild, Rue Manin, Paris, France.
American University of Beirut - Medical Center Beirut, Lebanon.
Am J Ophthalmol Case Rep. 2021 Jul 9;23:101162. doi: 10.1016/j.ajoc.2021.101162. eCollection 2021 Sep.
To report the use of Descemet Membrane Endothelial Keratoplasty (DMEK) for secondary surgical removal of intraocular foreign bodies (IOFB) years after the trauma as migration occurred through the endothelium, damaging the endothelium, and causing corneal edema.
We report the case of a blast injury in 1972, that led to left eye traumatic cataract managed with vitrectomy and lensectomy. Although thorough removal was attempted, some corneal and conjunctival foreign bodies remained.Despite aphakia, the patient maintained acceptable best corrected visual acuity (BCVA) (0.30 LogMAR) but >30 years later, experienced visual deterioration. IOFB protruding through the Descemet membrane (DM) were seen, with extensive edema. Descemet Membrane Endothelial Keratoplasty was performed in an attempt to treat the endothelium and remove the foreign bodies protruding through the DM. The procedure was done uneventfully under sulfur hexafluoride gas (SF6) and the patient improved. Four years after the surgery, BCVA was 0.63, however, 6 years later, a new episode of migrating intracorneal foreign bodies with corneal edema reduced BCVA to 0.40. The decision was made to observe the patient, and delay a second DMEK.
Corneal decompensation caused by IOFB breaching the Descemet membrane can safely be managed with a DMEK. DMEK is feasible even in complex cases and should be attempted due to its lower risk of graft rejection and likely benefits, while saving the option of more aggressive transplantation techniques, such as penetrating keratoplasty, in cases of failure.
报告在眼外伤多年后，因眼内异物（IOFB）通过内皮迁移，损伤内皮并导致角膜水肿，而采用后弹力层内皮角膜移植术（DMEK）进行二次手术取出眼内异物的情况。
我们报告了一例1972年的爆炸伤病例，该病例导致左眼外伤性白内障，接受了玻璃体切除术和晶状体切除术治疗。尽管尝试了彻底清除，但仍有一些角膜和结膜异物残留。尽管患者无晶状体，但仍保持了可接受的最佳矫正视力（BCVA）（LogMAR 0.30），但30多年后，视力出现恶化。可见IOFB穿过后弹力层（DM）突出，并伴有广泛水肿。为治疗内皮并取出穿过DM突出的异物，进行了后弹力层内皮角膜移植术。该手术在六氟化硫气体（SF6）下顺利完成，患者病情有所改善。手术后四年，BCVA为0.63，然而，六年后，角膜内异物再次迁移并伴有角膜水肿，使BCVA降至0.40。决定对患者进行观察，并推迟第二次DMEK手术。
IOFB穿透后弹力层引起的角膜失代偿可以通过DMEK安全地进行治疗。DMEK即使在复杂病例中也是可行的，由于其较低的移植排斥风险和可能的益处，应尝试采用，同时在失败的情况下保留更积极的移植技术，如穿透性角膜移植术的选择。
