Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
Turk J Ophthalmol. 2022 Feb 23;52(1):64-68. doi: 10.4274/tjo.galenos.2021.98478.
Descemet's membrane (DM) rupture/detachments have traditionally been treated conservatively, with limited efficacy and a long rehabilitation period that significantly affects patients' vision and quality of life. Although there are no established gold standards for the timing and nature of treatment, with this series of 4 cases we aimed to highlight the importance of the current optimal intervention methods. The first two patients were treated with anterior chamber injection of isoexpansile 14% C3F8 due to acute hydrops associated with keratoglobus in the first case and keratoconus in the second case. The third patient had keratoglobus and chronic hydrops complicated by multiple stromal clefts detected on anterior segment optical coherence tomography, and the fourth patient had a chronic broad DM detachment which occurred after cataract surgery. Both of these patients were treated with intracameral C3F8 injection together with corneal compressive sutures. In all four cases, DM reattached completely and effectively with surgical intervention. Surgical management of DM rupture/detachment with intracameral gas injection and compressive corneal sutures seems to provide fast symptomatic relief and less healing-related corneal scarring with better visual rehabilitation, and may alleviate the need for corneal transplant surgery in this group of patients.
传统上，对于Descemet 膜（DM）破裂/脱离，我们采用保守治疗，疗效有限，康复期长，严重影响患者的视力和生活质量。尽管目前对于治疗的时机和性质尚未建立明确的黄金标准，但通过这一系列的 4 个病例，我们旨在强调当前最佳干预方法的重要性。前两例患者因角膜球形变相关的急性水肿和第二例患者因圆锥角膜，采用前房内注射等张 14% C3F8 治疗。第三例患者角膜球形变且慢性水肿合并前节光学相干断层扫描发现多个基质裂，第四例患者白内障手术后发生慢性广泛 DM 脱离。这两例患者均采用房内 C3F8 注射联合角膜压缩缝线治疗。在所有 4 例患者中，DM 完全有效重新附着，手术干预效果良好。房内气体注射联合角膜压缩缝线治疗 DM 破裂/脱离，可快速缓解症状，减轻与愈合相关的角膜瘢痕，获得更好的视力恢复，可能减轻这组患者对角膜移植手术的需求。
