Modified deep anterior lamellar dissection for corneal opacity during vitrectomy: case reports
Modified deep anterior lamellar dissection for corneal opacity during vitrectomy: case reports
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DOI：
10.1186/s12886-020-01587-7
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发表时间：
2020-08-03
影响因子：
2
通讯作者：
Zhu, Dongqing
中科院分区：
文献类型：
--
作者：
Li, Fang;Zhang, Leilei;Zhu, Dongqing
背景介绍一种改良的深前板层剥离技术，以提高手术中合并角膜混浊的玻璃体视网膜疾病的可视性。病例介绍2例视网膜脱离合并角膜血染或角膜失代偿的患者接受了改良的深前板层剥离术，随后进行了玻璃体切除术。与典型的深前板层角膜移植术中的角膜板层剥离和去除不同，改良的深前板层剥离技术包括深板层角膜瓣的创建和保存，后向照明以可视化并容易地去除后弹力层上剩余的不透明基质，以及在内皮失代偿的眼中的大气泡技术。在玻璃体切除术后，将患者自身的角膜瓣缝合回去。改良的切割技术在玻璃体切除术中提供了足够的眼底视图，同时切除尽可能少的角膜组织，减少了手术并发症和对新鲜角膜的要求。例1术后角膜血染逐渐吸收，视力由光感提高到数指。在病例2中，尽管角膜仍然混浊且视力差，但角膜内皮失代偿稳定且无症状。在6个月随访时，硅油取出后，两个视网膜均附着。结论在玻璃体切除术合并角膜混浊的患者中，改良的有限深前板层角膜剥离术是穿透性角膜移植、眼内窥镜和临时人工角膜的有效替代方法。
Background To introduce a modified deep anterior lamellar dissection technique to improve visibility during surgery for vitreoretinal diseases with coexisting corneal opacity. Case presentation Two patients with retinal detachment and coexisting corneal blood staining or corneal decompensation underwent modified deep anterior lamellar dissections followed by vitrectomy. The modified deep anterior lamellar dissection techniques, unlike the dissection and removal of corneal lamellar in a typical deep anterior lamellar keratoplasty, included the creation and preservation of a deep lamellar corneal flap, the retroillumination to visualize and easily remove the remaining opaque stroma on the Descemet membrane, and the big air bubble technique in the eye with endothelial decompensation. The patient's own cornea flap was sutured back after vitrectomy was done. The modified dissection techniques provided adequate fundus view during vitrectomy while removing as less corneal tissue as possible and decreasing the surgical complications and the requirement of a fresh cornea. Postoperatively, in case 1, the corneal blood staining was gradually absorbed and the vision improved from light perception to counting fingers. In case 2, even though the cornea remained cloudy and the vision was poor, the cornea endothelial decompensation was stable and asymptomatic. Both retinas were attached after silicone oil removal at 6-month follow-up. Conclusions This modified and limited deep anterior lamellar corneal dissection procedure appears to be a useful alternative to penetrating keratoplasty, ophthalmic endoscope and temporary keratoprosthesis during the vitrectomy with coexisting corneal opacity.