Moura-Coelho Nuno, Arrondo Elena, Papa-Vettorazzi Mario Renato, Cunha João Paulo, Güell José Luis
Instituto Microcirurgia Ocular (IMO) Barcelona Grupo Miranza, Carrer Josep María Lladó 3, 08035, Barcelona, Spain.
NOVA Medical School | Faculdade de Ciências Médicas - Universidade Nova de Lisboa (NMS|FCM-UNL), Rua José António Serrano, 1169-050, Lisboa, Portugal.
Am J Ophthalmol Case Rep. 2022 Jul 10;27:101656. doi: 10.1016/j.ajoc.2022.101656. eCollection 2022 Sep.
To report a case of Descemet membrane endothelial keratoplasty (DMEK) for the management of post-laser in situ keratomileusis (LASIK) interface fluid syndrome (IFS) secondary to failed Descemet stripping automated endothelial keratoplasty (DSAEK) graft, and to provide a literature review on endothelial keratoplasty (EK) for this indication.
A 52-year-old patient presented with LASIK interface fluid accumulation and a non-functioning primary DSAEK graft. Past ophthalmic history was relevant for: (1) phakic intraocular lens (PIOL) implantation with later refinement by LASIK; (2) combined PIOL explantation and refractive lens exchange due to accelerated endothelial cell loss (ECL); (3) primary DSAEK due to corneal decompensation.A secondary EK graft (DMEK) was performed, and the patient was prospectively followed for 6 months (M6). DMEK surgery was uneventful, without postoperative graft detachment. Corneal clearing and resolution of interface fluid accumulation occurred during the first postoperative month. Best-corrected visual acuity (BCVA) improved from 20/800 Snellen to 20/25 Snellen at 3-month follow-up, remaining stable at M6. Due to a persistent rise in intraocular pressure (IOP), the patient underwent uneventful non-penetrating deep sclerectomy 2 months after DMEK, with controlled IOP and without accelerated ECL.
DMEK is feasible, effective, and safe in the management of IFS in cases where corneal endothelial failure plays a major role, even in complex eyes with previous EK grafts. Aggressive postoperative IOP control is warranted to decrease the risk of interface fluid recurrence and damage to the optic nerve. Studies with larger patient numbers are encouraged to ascertain the role of EK for this indication.
报告1例因Descemet膜剥除自动内皮角膜移植术（DSAEK）植片失败继发的准分子激光原位角膜磨镶术（LASIK）界面液体积聚综合征（IFS）行Descemet膜内皮角膜移植术（DMEK）治疗的病例，并对内皮角膜移植术（EK）用于该适应证进行文献综述。
1例52岁患者出现LASIK界面液体积聚，且初次DSAEK植片无功能。既往眼科病史包括：（1）植入有晶状体眼人工晶状体（PIOL），后行LASIK进行屈光矫正；（2）因内皮细胞丢失加速（ECL）行PIOL取出联合屈光性晶状体置换术；（3）因角膜失代偿行初次DSAEK。行二次EK植片（DMEK）手术，并对患者进行了6个月的前瞻性随访（M6）。DMEK手术过程顺利，术后未发生植片脱离。术后第1个月角膜清亮，界面液体积聚消退。随访3个月时，最佳矫正视力（BCVA）从Snellen 20/800提高到Snellen 20/25，在M6时保持稳定。由于眼压（IOP）持续升高，患者在DMEK术后2个月行非穿透性深层巩膜切除术，手术顺利，眼压得到控制，且未出现ECL加速。
在角膜内皮功能衰竭起主要作用的IFS病例中，即使是既往有EK植片的复杂眼，DMEK治疗也是可行、有效且安全的。积极的术后眼压控制对于降低界面液体积聚复发及视神经损伤风险是必要的。鼓励开展更大样本量的研究以确定EK在该适应证中的作用。
