Tectonic DSAEK for the Management of Impending Corneal Perforation
Tectonic DSAEK for the Management of Impending Corneal Perforation
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构造 DSAEK 用于治疗即将发生的角膜穿孔
DOI：
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
A. Ramirez
中科院分区：
文献类型：
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作者：
Enrique O. Graue;Isaac Zuñiga;J. Hernández;M. Jaimes;Patricia Chirinos;A. Navas;A. Ramirez
目的.报告一例继发于干眼症的严重角膜变薄的病例，采用构造性后弹力层剥脱自动板层角膜移植术（DSAEK）和羊膜移植治疗。方法.一名72岁男性，有长期2型糖尿病和干眼病史，右眼出现80%角膜变薄和水肿，无感染性疾病体征，最初使用局部未防腐润滑剂和20%自体血清滴剂进行治疗。8周后，缺损的大小和深度增加，直至后弹力层膨出形成。此后，他因地质构造原因接受了DSAEK。术后1个月，后板层移植物粘附良好，但仍存在4 mm的上皮缺损。然后进行多层羊膜移植。结果眼表愈合迅速，在2周内发生上皮再生。八个月后，眼表保持稳定且结构充足。结论结构性DSAEK联合多层羊膜移植不仅可以提供结构支持，避免角膜穿孔，而且还可以促进上皮再生和眼表愈合，减少伴随的炎症。
Purpose. To report a case of severe corneal thinning secondary to dry eye treated with a tectonic Descemet stripping automated lamellar keratoplasty (DSAEK) and amniotic membrane graft. Methods. A 72-year-old man with a history of long standing diabetes mellitus type 2 and dry eye presented with 80% corneal thinning and edema on the right eye and no signs of infectious disease, initially managed with topical unpreserved lubrication and 20% autologous serum drops. Eight weeks after, the defect advanced in size and depth until Descemetocele was formed. Thereafter, he underwent DSAEK for tectonic purposes. One month after the procedure, the posterior lamellar graft was well adhered but a 4 mm epithelial defect was still present. A multilayered amniotic membrane graft was then performed. Results. Ocular surface healed quickly and reepithelization occurred over a 2-week period. Eight months after, the ocular surface remained stable and structurally adequate. Conclusion. Tectonic DSAEK in conjunction with multilayered amniotic graft may not only provide structural support and avoid corneal perforation, but may also promote reepithelization and ocular surface healing and decrease concomitant inflammation.