Fisenko N V, Demura T A, Trufanov S V, Voronin G V
Research Institute of Eye Diseases, Moscow, Russia.
I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Vestn Oftalmol. 2022;138(2):81-86. doi: 10.17116/oftalma202213802181.
The two most used modifications of endothelial keratoplasty (EK) are Descemet's membrane endothelial keratoplasty (DMEK) and Descemet's stripping automated endothelial keratoplasty (DSAEK). The leading complication of EK surgeries is graft detachment in the early postoperative period. This article reports on two cases of endothelial graft adhesion depending on morphological characteristics of the Descemet's membrane (DM) removed during EK. In the first case, complete graft attachment to the recipient's posterior stroma was observed after DMEK. Morphological analysis of the DM showed clean stromal surface. In the second case there was a false chamber between the endothelial transplant and the posterior stroma of the patient. OCT scans revealed separate stromal fibers protruding into the false chamber; morphological analysis of the removed DM showed stromal fragments fixed to the anterior surface of the DM. The revealed changes indicate damage to the posterior stroma the suffered received during descemetorhexis, which may be the cause for incomplete graft attachment. Complete attachment after repeated EK (DSAEK) in this case was due to a thin stromal layer on the graft that provided high degree of adhesion to the posterior corneal surface. DSAEK can be indicated as a repeated EK surgery in cases of persistent endothelial graft non-attachment after DMEK.
内皮角膜移植术（EK）最常用的两种改良术式是Descemet膜内皮角膜移植术（DMEK）和Descemet膜剥除自动内皮角膜移植术（DSAEK）。EK手术的主要并发症是术后早期移植物脱离。本文报道了两例内皮移植物粘连的病例，这取决于EK术中切除的Descemet膜（DM）的形态学特征。在第一例中，DMEK术后观察到移植物完全附着于受体的后基质。DM的形态学分析显示基质表面干净。在第二例中，内皮移植物与患者的后基质之间存在假腔。光学相干断层扫描（OCT）显示有单独的基质纤维突入假腔；切除的DM的形态学分析显示有基质碎片附着于DM的前表面。所发现的变化表明在撕除Descemet膜时后基质受到损伤，这可能是移植物附着不完全的原因。在该病例中，重复进行EK（DSAEK）后移植物完全附着是由于移植物上有一层薄的基质层，该基质层与角膜后表面具有高度的粘附性。对于DMEK术后内皮移植物持续未附着的病例，DSAEK可作为重复EK手术的选择。
