Sheludchenko V M, Osipyan G A, Khraystin Kh, Dzhalili R A, Abukerimova A K
Krasnov Research Institute of Eye Diseases, Moscow, Russia.
Vestn Oftalmol. 2023;139(1):75-79. doi: 10.17116/oftalma202313901175.
Intrastromal corneal ring segments (ICRS) of in various shapes are used to correct structural changes in the cornea and improve visual acuity in keratoconus (KC). The most serious complications of the technology infection, vascular ingrowth, and extrusion. In this study a 44-year-old patient underwent deep anterior lamellar keratoplasty (DALK) 5 years after implantation of ICRS in the shape of an incomplete ring to treat its extrusion of up to 30%, vascular ingrowth into the cornea and corneal syndrome. The following DALK technique was used: excision of the free part of the corneal segment, removal of the remaining part of the corneal segment, excision of 80% of thickness of the corneal block with a 8.5-mm trepan, pneumatic dissection of the stroma down to the Descemet membrane (DM), removal of the remaining stroma on the viscoelastic pillow, laying and suture fixation of the donor graft. There were no complications during the postoperative period, the graft remained transparent for up to 10 months. Uncorrected visual acuity (UCVA) increased from 0.01 to 0.4, best corrected visual acuity (BCVA) increased from 0.3 to 0.7. The number of endothelial cells decreased from 2980 to 2670 cells/mm (10.4%). This clinical case demonstrates that DALK surgery can be a reliable method of patient rehabilitation in cases of extrusion of ICRS in the shape of an incomplete ring and vascular ingrowth.
各种形状的角膜基质内环形片段（ICRS）被用于矫正圆锥角膜（KC）的角膜结构变化并提高视力。该技术最严重的并发症是感染、血管长入和植入物挤出。在本研究中，一名44岁患者在植入不完全环形的ICRS 5年后，因植入物挤出达30%、角膜血管长入和角膜综合征而接受了深板层角膜移植术（DALK）。采用了以下DALK技术：切除角膜段的游离部分，切除角膜段的剩余部分，用8.5毫米环钻切除角膜块80%的厚度，对基质进行气体分离直至后弹力层（DM），在粘弹性垫上切除剩余的基质，铺设并缝合固定供体移植物。术后期间无并发症，移植物在长达10个月的时间内保持透明。未矫正视力（UCVA）从0.01提高到0.4，最佳矫正视力（BCVA）从0.3提高到0.7。内皮细胞数量从2980个/mm减少到2670个/mm（减少了10.4%）。该临床病例表明，对于不完全环形ICRS挤出和血管长入的病例，DALK手术可以是一种可靠的患者康复方法。
