前房游离滚动后保留原移植物的再去角膜内皮角膜移植术(DMEK):病例报告

A. Arnaiz Camacho, S. Martín Nalda, T. Pablos Jiménez, S. García Hidalgo, A. Pairó Salvador, M.A. Zapata Victori
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引用次数: 0

摘要

导言梁状角膜移植术在治疗内皮功能障碍引起的角膜水肿方面产生了巨大影响。微创移植技术,如去斑膜内皮角膜移植术(DMEK),有助于降低此类患者进行穿透性角膜移植术的发病率。临床病例 一位 89 岁的妇女患有 Fuchs 内皮营养不良症,接受了白内障和去角质膜内皮角膜移植术联合手术,术后 24 小时出现基质水肿(主要是下部)和移植物扇形脱落。在会诊中再次泡水后,4 天后,观察到移植物在前房内翻滚和游离。她接受了再次 DMEK 手术,24 小时后保留了原来的移植物,并进行了去表皮处理,以优化视野。移植物用胰蓝染色,后基质用空气保护。术后 24 小时,观察到粘连的移植物,基质水肿明显减轻。一个月后,患者的角膜变得清澈,移植物持续完全粘附,视力达到 0.9。 结论 DMEK 手术后在前房中发现游离辊是最复杂的移植物脱离形式。角膜水肿以及不同眼内结构的排列是手术解决这一并发症时需要考虑的条件。在许多情况下,手术重新定位移植物是可行的,这意味着无需使用新的供体角膜组织就能节省成本。
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Re-Descemet Membrane Endothelial Keratoplasty (DMEK) con preservación del injerto original tras free roll en cámara anterior: a propósito de un caso

Introduction

Lamellar keratoplasties have had a great impact in the management of corneal edema due to endothelial dysfunction. Minimally invasive transplant techniques such as descemet membrane endothelial keratoplasty (DMEK) have helped to reduce the morbidity involved in performing penetrating keratoplasty in this type of patient. Even so, these are complex techniques that are not free of complications and require a long line of surgical learning and an even more demanding experience in postoperative management.

Clinical case

An 89-year-old woman suffering from Fuchs endothelial dystrophy and undergoing combined cataract and DMEK surgery presented stromal edema predominantly inferior and sectoral detachment of the graft 24 h after the intervention. After re-bubbling in consultations and 4 days later, the graft was observed rolled and free in the anterior chamber.

She underwent re-DMEK with preservation of the original graft after 24 h, with de-epithelialization to optimize visualization. The graft was stained with trypan blue and the posterior stroma was protected with air. The graft was reimplanted under intraocular maneuvers and with an air bubble.

Twenty four hours after surgery, the adhered graft was observed, with a great decrease in stromal edema. One month later, the patient had a clear cornea, persistent complete graft adhesion, and visual acuity of 0.9.

Conclusion

The discovery of free roll in the anterior chamber after DMEK surgery constitutes the most complex form of graft detachment. Corneal edema as well as the arrangement of the different intraocular structures are conditions to be considered for the surgical resolution of this complication. In many cases, surgical repositioning of the graft is feasible, which means saving costs without the need to use new donor corneal tissues.

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来源期刊
CiteScore
1.20
自引率
0.00%
发文量
109
审稿时长
78 days
期刊介绍: La revista Archivos de la Sociedad Española de Oftalmología, editada mensualmente por la propia Sociedad, tiene como objetivo publicar trabajos de investigación básica y clínica como artículos originales; casos clínicos, innovaciones técnicas y correlaciones clinicopatológicas en forma de comunicaciones cortas; editoriales; revisiones; cartas al editor; comentarios de libros; información de eventos; noticias personales y anuncios comerciales, así como trabajos de temas históricos y motivos inconográficos relacionados con la Oftalmología. El título abreviado es Arch Soc Esp Oftalmol, y debe ser utilizado en bibliografías, notas a pie de página y referencias bibliográficas.
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