Spontaneous Corneal Clearance Despite Graft Detachment in Descemet Membrane Endothelial Keratoplasty
Spontaneous Corneal Clearance Despite Graft Detachment in Descemet Membrane Endothelial Keratoplasty
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DOI：
10.1016/j.ajo.2009.02.033
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发表时间：
2009-08-01
影响因子：
4.2
通讯作者：
Melles, Gerrit R. J.
中科院分区：
文献类型：
--
作者：
Balachandran, Chandra;Ham, Lisanne;Melles, Gerrit R. J.
目得：描述2例角膜后弹力层内皮角膜成形术（DMEK）后移植片几乎完全脱离的患者角膜透明度的自发恢复。设计：病例系列。方法：2例Fuchs内皮营养不良患者行DMEK。通过3 mm透明角膜隧道切口，将受体后弹力层及其内皮从后基质剥离。一个9.5毫米直径的器官培养的Descemet卷被插入到受体前房，定位到后基质，并通过一个完整的空气填充的前房45 minutes.Results：在1个月后，平安无事的DMEK，两个移植的角膜表现出失代偿归因于次全移植物脱离。出乎意料的是，角膜透明度自发改善，在3个月时，尽管移植物持续脱离，但两个移植角膜的角膜厚度均正常。术后视力提高20/50（0.4）和20/25（0.8）3个月至20/28（0.7）和20/20（1.0）。结论：在存在分离的DMEK移植物的情况下的角膜清除与内皮角膜移植术的当前概念不一致，这需要受体角膜后表面处的（附着的）供体内皮细胞层。来自供体或受体的内皮细胞转移、迁移、再生或其组合可以解释视力恢复。这些观察结果表明，我们的方法进行审查内皮角膜移植术和角膜内皮疾病的管理可能是必要的。(Am J Ophthalmol 2009;148：227-234. (C)2009年，Elsevier Inc.版权所有© 2016
PURPOSE: To describe spontaneous recovery of corneal transparency in 2 cases with nearly complete graft detachment after Descemet membrane endothelial kerato, plasty (DMEK).DESIGN: Case series.METHODS: In 2 patients with Fuchs endothelial dystrophy, DMEK was performed. Through a 3-mm clear corneal tunnel incision, the recipient Descemet membrane and its endothelium was stripped off from the posterior stroma. A 9.5-mm diameter organ-cultured Descemet roll was inserted into a recipient anterior chamber, positioned onto the posterior stroma, and secured by a complete air filling of the anterior chamber for 45 minutes.RESULTS: At 1 month after uneventful DMEK, both transplanted corneas showed decompensation attributable to subtotal graft detachment. Unexpectedly, corneal transparency improved spontaneously, and at 3 months, both transplanted corneas had a normal pachymetry, despite persistent graft detachment. The patients' visual acuities improved to 20/50 (0.4) and 20/25 (0.8) at 3 months to 20/28 (0.7) and 20/20 (1.0), respectively at 9 months.CONCLUSIONS: Corneal clearance in the presence of a detached DMEK graft is not consistent with the current concept of endothelial keratoplasty, which requires an (attached) donor endothelial cell layer at the recipient posterior corneal surface. Endothelial transfer, migration, regeneration, or a combination thereof from either the donor or the recipient may explain the visual recovery. These observations suggest that a review of our approach to endothelial keratoplasty and the management of corneal endothelial disorders may be warranted. (Am J Ophthalmol 2009;148:227-234. (C) 2009 by Elsevier Inc. All rights reserved.)