Nariya Yuta, Ono Takashi, Asahina Yuichi, Kondo Atsushi, Taketani Yukako, Kimakura Mikiko, Toyono Tetsuya, Aihara Makoto, Miyai Takashi
Department of Ophthalmology, University of Tokyo Hospital, Tokyo, Japan.
Department of Pathology, University of Tokyo Hospital, Tokyo, Japan.
Case Rep Ophthalmol. 2024 Jun 26;15(1):518-524. doi: 10.1159/000539392. eCollection 2024 Jan-Dec.
Corneal graft detachment is a major postoperative complication of Descemet's stripping automated endothelial keratoplasty (DSAEK). When a corneal graft becomes detached, corneal endothelial function generally fails, and repeat corneal transplantation is required. Herein, we report a rare case in which a transparent cornea was maintained after the removal of a dislocated DSAEK graft.
A 79-year-old woman with a residual lens cortex who had undergone cataract surgery was referred to our hospital. The cortex was removed, and bullous keratopathy progressed. Six months after the initial surgery, DSAEK was performed under topical anesthesia without any complications. Although the corneal graft had attached fairly well, it detached from the host cornea 3 weeks later. Two months after DSAEK, an air tamponade was used to treat the anterior chamber with single interrupted suturing; however, the graft detached again, except for the suture site. Because the detached cornea became cloudy in the anterior chamber, it was surgically removed 8 months after DSAEK. Accordingly, the host cornea transparency improved to a best-corrected visual acuity of 0.8 with a rigid gas permeable lens and a central corneal thickness of 580 μm. The corneal endothelial cell density was 995 cells/mm.
Removal of the corneal graft from the dislocated cloudy graft improved the visual acuity of this patient after DSAEK. The condition of the cornea should be carefully monitored after corneal endothelial transplantation, even after the graft has been dislocated.
角膜移植片脱离是深板层角膜内皮移植术（DSAEK）的一种主要术后并发症。当角膜移植片发生脱离时，角膜内皮功能通常会丧失，需要再次进行角膜移植。在此，我们报告一例罕见病例，在移除脱位的DSAEK移植片后，透明角膜得以保留。
一名79岁患有残留晶状体皮质且已接受白内障手术的女性被转诊至我院。移除了皮质，大泡性角膜病变进展。初次手术后6个月，在表面麻醉下进行了DSAEK，无任何并发症。尽管角膜移植片附着良好，但3周后它从宿主角膜脱离。DSAEK术后2个月，采用空气填塞并单间断缝合治疗前房；然而，除缝合部位外，移植片再次脱离。由于脱离的角膜在前房内变混浊，在DSAEK术后8个月将其手术移除。因此，佩戴硬性透气性角膜接触镜时，宿主角膜透明度提高，最佳矫正视力达到0.8，中央角膜厚度为580μm。角膜内皮细胞密度为995个细胞/mm²。
从脱位混浊的移植片中移除角膜移植片提高了该患者DSAEK术后的视力。即使在移植片脱位后，角膜内皮移植术后也应仔细监测角膜情况。
