Graft Edge Reflection of a Tightly Scrolled Roll Using Endoillumination as a Simple Method for Determining Graft Orientation in Descemet Membrane Endothelial Keratoplasty
Graft Edge Reflection of a Tightly Scrolled Roll Using Endoillumination as a Simple Method for Determining Graft Orientation in Descemet Membrane Endothelial Keratoplasty
复制标题
DOI：
10.1097/ico.0000000000002459
复制
发表时间：
2021-02-01
期刊：
影响因子：
2.8
通讯作者：
Sugiyama, Kazuhisa
中科院分区：
文献类型：
--
作者：
Kobayashi, Akira;Yokogawa, Hideaki;Sugiyama, Kazuhisa
目的：描述一个简单的发现，可用于确定后弹力层内皮角膜移植术（DMEK）中供体组织的方向。这涉及使用来自内照明器的光从前房内的重叠移植物边缘出现高反射性圆形曲线。我们在这里命名这个小林标志（K标志）。方法：对12例接受DMEK的患者的12只连续眼进行K征评估。还评价了Berrospi征（B征）的存在，这是一种来自后弹力膜（DM）卷外周卷曲的双线反射，据报道可用于正确的移植物定向。结果如下：在12例中，3例供体在DM供体插入后不久显示松散的滚动;所有3例仅在使用内窥镜时显示阳性B征。9名供体显示出紧密滚动的DM卷，无B征;在这9名供体中，仅在使用内窥镜照明器时，7例病例中可见K征。其余2例紧卷配置的病例即使使用腔内照明也未显示K征，表明卷边缘完全向下;使用穿刺液的小射流旋转卷显示这些病例中的K征。结论：该技术可用于确定紧密滚动的DM卷的正确方向，从而实现快速DMEK手术。对于松散滚动的DM卷，内照明增强的B-sing被证明是有用的。
Purpose: To describe a simple finding that can be used to determine donor tissue orientation in Descemet membrane endothelial keratoplasty (DMEK). This involves the appearance of a highly reflective round curved line from an overlapping graft edge within the anterior chamber using light from an endoilluminator. We here name this Kobayashi sign (K-sign). Methods: Twelve consecutive eyes from 12 patients who underwent DMEK were evaluated for the presence of a K-sign. The presence of Berrospi sign (B-sign), a double-line reflection from the peripheral curls of the Descemet membrane (DM) roll that has been reported to be useful for correct graft orientation, was also evaluated. Results: Of 12 cases, 3 donors showed a loosely scrolled roll soon after DM donor insertion; all 3 of these showed a positive B-sign only when the endoilluminator was used. Nine donors showed a tightly scrolled DM roll without a B-sign; among these 9 donors, a K-sign was visible in 7 cases only when the endoilluminator was used. The remaining 2 cases with a tight scroll configuration showed no K-sign even with the use of endoillumination, indicating that the roll edge was located completely downward; rotation of the roll using a small jet of fluid from paracentesis revealed K-sign in these cases. Conclusions: This technique is useful for determining the correct orientation of a tightly scrolled DM roll, subsequently enabling rapid DMEK surgery. For loosely scrolled DM roll, endoillumination enhanced B-sing is proven useful.