Intraoperative perforation of Descemet's membrane during "big bubble" deep anterior lamellar keratoplasty
Intraoperative perforation of Descemet's membrane during "big bubble" deep anterior lamellar keratoplasty
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DOI：
10.1007/s10792-009-9334-7
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发表时间：
2010-06-01
影响因子：
1.6
通讯作者：
Vajpayee, Rasik B.
中科院分区：
文献类型：
--
作者：
Jhanji, Vishal;Sharma, Namrata;Vajpayee, Rasik B.
目的分析深前板层角膜移植术（DALK）术中角膜后弹力层穿孔的原因。在33例患者的35只眼中尝试了DALK，这些患者的病理涉及角膜基质和保留后弹力层（DM），包括圆锥角膜、角膜基质营养不良和愈合的角膜炎患者。手术计划包括使用“大泡”技术完全去除角膜基质，暴露后弹力层，然后移植全层角膜基质微囊。8只眼（23%）DALK转为全层穿透性角膜移植术，其中包括圆锥角膜（n = 6）、黄斑角膜营养不良（n = 1）和治愈性角膜炎（n = 1）患者。转换的主要原因是由于过量空气注入（4只眼）和手术操作不当（3只眼）导致DM穿孔。1例病例在暴露DM后后弹力膜上有沉积物。所有8只眼均可成功施行穿透性角膜移植术。在学习曲线期间，过量的空气注入和不适当的手术操作可能使DALK复杂化，导致转换为穿透性角膜移植术。
To analyze the reasons for intraoperative perforation of Descemet's membrane during deep anterior lamellar keratoplasty (DALK) during the learning curve. DALK was attempted in 35 eyes of 33 patients with pathologies involving the corneal stroma and sparing of Descemet's membrane (DM), including patients with keratoconus, corneal stromal dystrophies and healed keratitis. The surgical plan included complete removal of the corneal stroma using the "big bubble" technique for exposing Descemet's membrane followed by grafting of a full-thickness corneal stromal lenticule. DALK was converted into full-thickness penetrating keratoplasty in eight eyes (23%), which included patients with keratoconus (n = 6), macular corneal dystrophy (n = 1) and healed keratitis (n = 1). Main reasons for conversion were perforation of the DM due to excessive air injection (four eyes) and improper surgical maneuvers (three eyes). One case had deposits on Descemet's membrane upon exposure of the DM. A successful penetrating keratoplasty could be performed in all eight eyes. During the learning curve, excessive air injection and inappropriate surgical maneuvers may complicate a DALK resulting in conversion to penetrating keratoplasty.