Lomi Neiwete, Das Deepsekhar, Vanathi M, Gupta Noopur, Chawla Bhavna, Tandon Radhika
Department of Ophthalmology, Cornea and Ocular Oncology Services, All India Institute of Medical Sciences, New Delhi, India.
Indian J Ophthalmol. 2025 Jul 1;73(7):1088. doi: 10.4103/IJO.IJO_2957_24. Epub 2025 Jun 30.
Descemet stripping automated endothelial keratoplasty (DSAEK) is a popular posterior lamellar keratoplasty used to tackle corneal decompensation secondary to endothelial damage. The surgical procedure involves removing the corneal stroma, Descemet's membrane along with the affected endothelium from the host, and then transplanting the same from the donor cornea.[1] During the surgery, fluid accumulation in between the DSAEK lenticule and the host corneal stroma is common occurrence. This interface fluid if not removed can lead improper positioning of the donor lenticule and in certain instances lenticule displacement. External corneal massage is a popular technique which is employed in order to evacuate this interface fluid.[2,3].
Lomi Lomi massage is a massage technique where the masseuse uses the back of both forearms alternately in a kneading fashion.[4] The authors describe a similar pattern of massage using 2 26G cannula in order to clear the interface fluid.
The bimanual kneading movement acts by pressing the anterior lamella down, with the air bubble in the anterior chamber giving counter traction the lenticule from below. In the continuous Lomi Lomi movements, one instrument is kept pressed on the host anterior lamella which prevents the backflow of the fluid, whereas the advancement of the second instrument leads to squeezing of the remaining fluid out of the interface. Although certain instruments, namely, DSAEK roller, have been described for the evacuation of interface fluid, a long-term prospective study is required to compare effectiveness, ease of use, safety, clinical outcomes, and surgeon preference between it and Lomi Lomi massage technique to conclude which is better.
Lomi Lomi corneal massage can be used to clear interface fluid in DSAEK surgery.
深板层角膜内皮移植术（DSAEK）是一种常用的后板层角膜移植术，用于治疗因内皮损伤继发的角膜失代偿。手术过程包括从受体角膜移除角膜基质、后弹力层以及受影响的内皮，然后从供体角膜移植相同组织。[1] 在手术过程中，DSAEK 植片与受体角膜基质之间积液是常见现象。如果不清除这种界面液体会导致供体植片定位不当，在某些情况下还会导致植片移位。外部角膜按摩是一种常用的清除这种界面液体的技术。[2,3]
洛米洛米按摩是一种按摩技术，按摩师交替使用双前臂背面以揉捏方式进行按摩。[4] 作者描述了一种类似的按摩方式，使用两根 26G 套管针来清除界面液体。
双手揉捏动作通过向下按压前板层起作用，前房内的气泡从下方给予植片反向牵引力。在持续的洛米洛米动作中，一个器械持续按压受体前板层以防止液体回流，而第二个器械向前推进则将剩余液体从界面挤出。尽管已经描述了某些器械，即 DSAEK 滚轮，用于清除界面液体，但需要进行长期前瞻性研究，以比较它与洛米洛米按摩技术在有效性、易用性、安全性、临床结果和外科医生偏好方面的差异，从而得出哪种方法更好的结论。
洛米洛米角膜按摩可用于清除 DSAEK 手术中的界面液体。
