Cornea Department, Disha Eye Hospitals, Barrackpore, Kolkata, India.
Cornea. 2022 Jul 1;41(7):927-932. doi: 10.1097/ICO.0000000000003043. Epub 2022 Apr 13.
The purpose of this study was to report a novel technique of donor lenticule insertion in Descemet stripping endothelial keratoplasty (DSEK) in aphakic corneal edema with large iris defect and without any posterior capsular support.
This was a retrospective consecutive interventional case series. Clinical records of ten 1-eyed aphakic patients with corneal edema with large iris defect and no capsular support who underwent air-assisted donor lenticule insertion in DSEK were evaluated. After making 6.0- to 6.5-mm sclerocorneal tunnel and 2 side ports, limited anterior vitrectomy was performed if required. Then, Descemetorhexis was performed under air through side ports. Manually dissected donor lenticule was inserted into the anterior chamber under full-chamber air by a 30-G needle push-in technique. Further air tamponade was given if necessary. No fluid-air exchange was performed. The patient was kept on the same operating table for at least 1 hour and then shifted. Graft attachments in early postoperative period, corrected distant visual acuity, and endothelial cell density after 3, 6, and 12 months were analyzed.
The mean postoperative follow-up period was 19.2 ± 6.7 months. There was no donor dislocation in this small group. All patients achieved a corrected distant visual acuity of 0.70 (20/100) after 3 months and maintained until 12 months. The endothelial cell density at 3 months (n = 8) was 2028 ± 151/mm 2 , at 6 months (n = 7) 1776 ± 198/mm 2 , and at 12 months (n = 7) 1721 ± 172/mm 2 . The corresponding endothelial cell loss was 25.8% ± 5.6%, 34.4% ± 5.1%, and 37.8% ± 7.1%, respectively. One graft failed after 15 months.
"Air-assisted" donor lenticule insertion in DSEK is a safe surgical technique in aphakic patients with corneal edema with large iris defect and no capsular support.
本研究旨在报告一种在无晶状体眼角膜水肿伴大虹膜缺损且无后囊膜支撑的情况下，于撕囊内皮角膜移植术（DSEK）中进行供体微透镜插入的新方法。
这是一项回顾性连续干预性病例系列研究。评估了 10 名单眼无晶状体患者的临床记录，这些患者因角膜水肿伴大虹膜缺损且无囊膜支撑而接受了 DSEK 中的空气辅助供体微透镜插入。完成 6.0-6.5mm 巩膜角膜隧道和 2 个侧切口后，如果需要，则进行有限的前段玻璃体切除术。然后，通过侧切口在空气中进行 Descemet 撕囊。通过 30-G 针推注技术将手动解剖的供体微透镜插入前房的全室空气中。如有必要，进一步进行空气填塞。未进行液体-空气交换。患者在同一手术台上至少保持 1 小时，然后转移。分析术后早期的移植物附着、矫正远视力和术后 3、6 和 12 个月的内皮细胞密度。
平均术后随访时间为 19.2±6.7 个月。在这个小群体中，没有供体脱位的情况。所有患者在术后 3 个月时均获得 0.70（20/100）的矫正远视力，并保持至 12 个月。术后 3 个月（n=8）时的内皮细胞密度为 2028±151/mm 2 ，术后 6 个月（n=7）时为 1776±198/mm 2 ，术后 12 个月（n=7）时为 1721±172/mm 2 。相应的内皮细胞丢失率分别为 25.8%±5.6%、34.4%±5.1%和 37.8%±7.1%。1 例移植物在术后 15 个月时失功。
在无晶状体眼角膜水肿伴大虹膜缺损且无囊膜支撑的情况下，DSEK 中的“空气辅助”供体微透镜插入是一种安全的手术技术。
