A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.
Vietnam National Eye Hospital, Hanoi, Vietnam.
Vestn Oftalmol. 2023;139(1):55-66. doi: 10.17116/oftalma202313901155.
The study aimed to develop new surgical methods of obtaining and preserving pre-Descemet's endothelial keratoplasty (PDEK) graft in order to reduce the loss of donor material.
The study was conducted on 30 sclerocorneal discs, which were divided into three groups. The first group consisted of 10 sclerocorneal discs to which the standard PDEK graft preparation technique was applied. The second group consisted of 10 sclerocorneal discs, where the PDEK graft preparation was done using the optimized method 1 involving the KD Ring fixator, KD Base for PDEK, KD-30G needle with 5 mL syringe connected to the spring-load plunger, a preservative solution. The third group consisted of 10 sclerocorneal discs with PDEK graft prepared using the optimized method 2, which differed from the optimized method 1 in additional use of the KD artificial chamber for PDEK. When successfully acquiring the type-1 "big bubble", the dissected PDEK graft was preserved for further use in clinical practice using our own technique.
In the first group, formation of the type-1 «big bubble» was achieved only in 5 out of 10 donor corneas (50%). Bubble ruptures happened in 4 cases (40%) and type-2 «big bubble» occurred in 1 case (10%). In the second group (optimized method 1) the type-1 «big bubble» was achieved in 9 cases (90%), while in the third group (optimized method 2) the type-1 «big bubble» was achieved in 10 cases (100%), proving the effectiveness of our PDEK graft preparation technique.
We presented a novel surgical approach for acquiring and preserving PDEK graft that minimizes almost all the difficulties that surgeons face, including bubble rupture during pneumodissection and hydrodissection, formation of type-2 and mixed type bubble, and obtaining a PDEK graft of the required size; the details of the surgical technique have been refined. The proposed technique for graft preparation and preservation can be easily implemented in eye banks and is convenient for clinical practice.
本研究旨在开发新的获取和保存前 Descemet 内皮层角膜移植（PDEK）移植物的手术方法，以减少供体材料的损失。
本研究共纳入 30 个硬角膜盘，将其分为三组。第一组包括 10 个硬角膜盘，应用标准的 PDEK 移植物制备技术。第二组包括 10 个硬角膜盘，使用优化方法 1 进行 PDEK 移植物制备，该方法包括 KD 环固定器、PDEK 的 KD Base、连接到弹簧加载柱塞的 5ml 注射器的 KD-30G 针头、保存液。第三组包括 10 个硬角膜盘，使用优化方法 2 制备 PDEK 移植物，与优化方法 1 不同的是，该方法还额外使用了 KD 人工房用于 PDEK。当成功获得 1 型“大气泡”时，采用我们自己的技术将解剖的 PDEK 移植物保存下来，以备将来在临床实践中使用。
在第一组中，仅在 10 个供体角膜中的 5 个（50%）中形成了 1 型“大气泡”。在 4 例（40%）中发生了气泡破裂，在 1 例（10%）中发生了 2 型“大气泡”。在第二组（优化方法 1）中，9 例（90%）获得了 1 型“大气泡”，而在第三组（优化方法 2）中，10 例（100%）获得了 1 型“大气泡”，证明了我们的 PDEK 移植物制备技术的有效性。
我们提出了一种新的获取和保存 PDEK 移植物的手术方法，最大限度地减少了外科医生面临的几乎所有困难，包括在气动剖检和水力剖检过程中气泡破裂、形成 2 型和混合型气泡以及获得所需大小的 PDEK 移植物；手术技术的细节已经得到了完善。提出的移植物制备和保存技术易于在眼库中实施，并且便于临床实践。
