Roig-Revert María José, Arias-García Elena, Ortega-Pérez Carolina, Peris-Martínez Cristina
FISABIO Ophthalmology Mediterranean Foundation, Valencia, Spain.
Optom Vis Sci. 2023 Dec 1;100(12):882-886. doi: 10.1097/OPX.0000000000002082. Epub 2023 Oct 25.
Some patients show poor visual outcomes after Descemet stripping automated endothelial keratoplasty. In such cases, secondary Descemet membrane endothelial keratoplasty can be performed to achieve complete visual recovery. Anterior segment optical coherence tomography (AS-OCT) is a valuable tool for the follow-up of posterior lamellar keratoplasty outcomes and complications.
This study aimed to report the clinical outcome of secondary Descemet membrane endothelial keratoplasty for managing poor visual results in a patient with graft failure after a previous Descemet stripping automated endothelial keratoplasty, highlighting the importance of AS-OCT in the follow-up of endothelial keratoplasty.
A 38-year-old woman with high myopia underwent Descemet stripping automated endothelial keratoplasty for bullous keratopathy after explantation of an angle-supported phakic intraocular lens. Two years after keratoplasty, the patient experienced poor visual acuity (counting fingers), and significant corneal edema was observed on clinical examination hindering visualization of the anterior chamber structures. Anterior segment optical coherence tomography showed a failed and thickened graft adhering well to the recipient cornea in an anterior chamber without other comorbidities. Therefore, the graft was removed and replaced with a Descemet membrane endothelial keratoplasty graft without any complications. One year later, the clinical outcome was evaluated by comparing the pre-operative and post-operative best-corrected visual acuity, biomicroscopy findings, endothelial cell density, and corneal central thickness.
Anterior segment optical coherence tomography is an important tool when deciding on the surgical technique to be applied and for the post-surgical monitoring of endothelial corneal grafts. This case demonstrates the successful management of Descemet stripping automated endothelial keratoplasty graft failure with Descemet membrane endothelial keratoplasty graft, highlighting the importance of AS-OCT in detecting complications such as graft dislocation and primary graft failure. In addition, corneal thickness measured using AS-OCT serves as a critical predictor of graft failure, as observed in this case.
一些患者在进行角膜后弹力层剥除自动内皮角膜移植术后视力恢复不佳。在这种情况下，可进行二次角膜后弹力层内皮角膜移植术以实现完全的视力恢复。眼前节光学相干断层扫描（AS-OCT）是用于随访后板层角膜移植术效果和并发症的重要工具。
本研究旨在报告二次角膜后弹力层内皮角膜移植术治疗先前角膜后弹力层剥除自动内皮角膜移植术后移植物失败导致视力不佳患者的临床结果，强调AS-OCT在内皮角膜移植术随访中的重要性。
一名38岁高度近视女性在取出有晶体眼人工晶状体后因大泡性角膜病变接受了角膜后弹力层剥除自动内皮角膜移植术。角膜移植术后两年，患者视力差（仅能数指），临床检查发现角膜显著水肿，妨碍了前房结构的观察。眼前节光学相干断层扫描显示移植物失败且增厚，在前房内与受体角膜紧密粘连，无其他合并症。因此，移除原移植物，并用角膜后弹力层内皮角膜移植移植物进行替换，未出现任何并发症。一年后，通过比较术前和术后的最佳矫正视力、生物显微镜检查结果、内皮细胞密度和角膜中央厚度来评估临床结果。
眼前节光学相干断层扫描在决定应用的手术技术以及内皮角膜移植物的术后监测方面是一项重要工具。本病例展示了用角膜后弹力层内皮角膜移植移植物成功处理角膜后弹力层剥除自动内皮角膜移植移植物失败的情况，强调了AS-OCT在检测移植物脱位和原发性移植物失败等并发症方面的重要性。此外，如本病例所示，使用AS-OCT测量的角膜厚度是移植物失败的关键预测指标。
