Igarashi Ami, Yokogawa Hideaki, Shimizu Toshiki, Kobayashi Akira, Yamagami Satoru, Hayashi Takahiko
Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Itabashi, Tokyo, Japan; and.
Department of Ophthalmology, Kanazawa University Hospital, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan.
Cornea. 2024 Jun 1;43(6):799-803. doi: 10.1097/ICO.0000000000003533. Epub 2024 Mar 12.
Several techniques have been developed for graft unfolding approaches in Descemet membrane endothelial keratoplasty (DMEK). However, despite these techniques, graft deployment and configuration in eyes with deep anterior chambers remain challenging in some cases. Therefore, in this study, we described a modified technique for DMEK, known as the "double-bubble technique assisted by holding forceps."
This was a retrospective interventional case series. Patients who underwent DMEK between August 2022 and July 2023, including cases with a history of vitrectomy and scleral fixation of intraocular lens, were enrolled in this study. Two experienced surgeons performed DMEK. In brief, after graft insertion into the anterior chamber, the first bubble with a small volume of air was injected above the graft to open the tight roll, and the graft edge was held using a 25-gauge graft manipulator. The second bubble was injected underneath the graft for fixation, while the graft edge was grasped using forceps during gas injection. The graft was released from the forceps. Best spectacle corrected visual acuity, central corneal thickness, endothelial cell density, and incidence of postoperative complications were measured before and after DMEK.
Eleven eyes of 11 patients were included in this study (mean follow-up period, 4.5 ± 4.4 months). Best spectacle corrected visual acuity and central corneal thickness significantly improved postoperatively ( P < 0.001). Rebubbling was required in 2 eyes; no other postoperative complications or primary graft failure were observed.
The present technique enables safe and feasible DMEK surgery in vitrectomized eyes with scleral fixated IOLs and in those with a deep anterior chamber.
在Descemet膜内皮角膜移植术（DMEK）中，已经开发了几种用于移植物展开的技术。然而，尽管有这些技术，但在某些情况下，前房较深的眼中移植物的展开和构型仍然具有挑战性。因此，在本研究中，我们描述了一种改良的DMEK技术，即“镊子辅助双气泡技术”。
这是一项回顾性介入病例系列研究。纳入2022年8月至2023年7月期间接受DMEK手术的患者，包括有玻璃体切除术和人工晶状体巩膜固定术病史的病例。由两名经验丰富的外科医生进行DMEK手术。简而言之，将移植物插入前房后，在移植物上方注入少量空气形成第一个气泡以打开紧密的卷边，并用25号移植物操纵器固定移植物边缘。在移植物下方注入第二个气泡以进行固定，在注入气体期间用镊子抓住移植物边缘。移植物从镊子上松开。在DMEK手术前后测量最佳矫正视力、中央角膜厚度、内皮细胞密度和术后并发症发生率。
本研究纳入了11例患者的11只眼（平均随访期4.5±4.4个月）。术后最佳矫正视力和中央角膜厚度显著改善（P<0.001）。2只眼需要再次注气；未观察到其他术后并发症或原发性移植物失败。
本技术能够在有巩膜固定人工晶状体的玻璃体切除眼中以及前房较深的眼中安全可行地进行DMEK手术。
