Srujana Dubbaka, Bista Nabaratna, Agrawal Mohini
Department of Ophthalmology, Armed Forces Medical College, Pune, Maharashtra, India.
Oman J Ophthalmol. 2022 Aug 3;15(3):337-341. doi: 10.4103/ojo.ojo_130_21. eCollection 2022 Sep-Dec.
Automated microkeratome is commonly used to get donor lenticules for Descemet stripping endothelial keratoplasty (DSEK); however, manual dissection of donor lenticules is also being done with good outcomes.
The aim of this study was to describe the results of manual DSEK performed in cases of corneal endothelial dysfunction caused due to pseudophakic bullous keratopathy, iridocorneal endothelial syndrome, and postpenetrating keratoplasty graft failure.
This was a retrospective observational study. The medical records of all patients with corneal decompensation who underwent DSEK at a tertiary care center performed by the same surgeon were reviewed. A standard DSEK with manually dissected donor lenticules was performed in all cases with the exception of the Descemet membrane not being removed in two cases. A comprehensive ophthalmic examination was performed preoperatively and at each postoperative visit in all patients.
Eight eyes of seven patients (four males and three females) were included. The mean age was 64.8 years (range, 49-74 years). The average follow-up was 10.9 months (range, 5-22 months). There was one case of primary graft failure which was managed by repeat DSEK. In the rest, corneas remained clear at the last follow-up. No rebubbling was done as none of the cases showed graft detachment. The preoperative best-corrected visual acuity (BCVA) was 20/2000 or less, and postoperatively, BCVA attained was 20/30 in four eyes and one eye achieved 20/80.
Manual DSEK performed in eyes with corneal decompensation allowed rapid restoration of corneal clarity while minimizing intraoperative and postoperative complications.
自动微型角膜刀常用于获取供体角膜瓣以进行后弹力层剥除内皮角膜移植术（DSEK）；然而，手动剖切供体角膜瓣也能取得良好效果。
本研究旨在描述在因人工晶状体性大泡性角膜病变、虹膜角膜内皮综合征及穿透性角膜移植术后移植失败导致角膜内皮功能障碍的病例中进行手动DSEK的结果。
这是一项回顾性观察研究。回顾了在一家三级医疗中心由同一位外科医生为所有角膜失代偿患者进行DSEK的病历。除两例未去除后弹力层外，所有病例均采用手动剖切供体角膜瓣的标准DSEK。所有患者术前及术后每次复诊时均进行全面的眼科检查。
纳入了7例患者（4例男性和3例女性）的8只眼。平均年龄为64.8岁（范围49 - 74岁）。平均随访时间为10.9个月（范围5 - 22个月）。有1例原发性移植失败，通过再次DSEK进行处理。其余病例在最后一次随访时角膜保持透明。由于所有病例均未出现移植片脱离，因此未进行气泡注入。术前最佳矫正视力（BCVA）为20/2000或更低，术后，4只眼的BCVA达到20/30，1只眼达到20/80。
在角膜失代偿的眼中进行手动DSEK可使角膜迅速恢复透明，同时将术中及术后并发症降至最低。
