Retained Host Descemet Membrane (Auto-DMET) During Conversion of Deep Anterior Lamellar Keratoplasty to Penetrating Keratoplasty: A Case Report

被引:0
作者
Vianna, Lucas M. M. [1 ,2 ,3 ]
Woreta, Fasika [1 ]
Kiely, Amanda E. [1 ]
Jun, Albert S. [1 ]
机构
[1] Johns Hopkins Sch Med, Wilmer Eye Inst, Dept Ophthalmol, Cornea & Anterior Segment Serv, Baltimore, MD USA
[2] Univ Fed Sao Paulo, Dept Ophthalmol, Paulista Sch Med, Sao Paulo, Brazil
[3] Univ Estado Rio De Janeiro, Dept Ophthalmol, Rio De Janeiro, Brazil
关键词
cornea; keratoconus; penetrating keratoplasty; deep anterior lamellar keratoplasty; Descemet membrane; ENDOTHELIAL-CELL LOSS; BIG-BUBBLE TECHNIQUE; CORNEAL CLEARANCE; PERFORATION; OUTCOMES;
D O I
10.1097/ICO.0000000000000162
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
Purpose: The aim of this study was to relate a case of deep anterior lamellar keratoplasty (DALK) converted to penetrating keratoplasty in which the host central Descemet membrane (DM) with a large perforation was left attached to the host cornea. Methods: This is a case report of a 34-year-old man who underwent an attempted DALK for keratoconus in his left eye, which became complicated with a large rupture in DM during dissection. The host DM was left in place, the donor cornea with DM intact was sutured onto the host bed, and air was injected into the anterior chamber. The patient was monitored by biomicroscopy, pachymetry, topography, anterior segment optical coherence tomography, and specular microscopy. Results: The postoperative course resulted in improved uncorrected visual acuity, best spectacle-corrected visual acuity, and topography. Corneal edema was observed in the host cornea peripheral to the graft. Three months after the surgery, the endothelial cell density was reduced by 63% compared with the preoperative donor cell density. Conclusions: Leaving the host DM during conversion of DALK to penetrating keratoplasty was uneventful in this case, although corneal edema was observed in the area overlying the host cornea. It is possible that the retained DM could provide additional autologous endothelial cells to prolong graft survival.
引用
收藏
页码:865 / 867
页数:3
相关论文
共 16 条
[1]   Immediate Endothelial Cell Loss After Penetrating Keratoplasty [J].
Alqudah, Asem A. ;
Terry, Mark A. ;
Straiko, Michael D. ;
Greiner, Mark A. ;
Davis-Boozer, David .
CORNEA, 2013, 32 (12) :1587-1590
[2]   Big-bubble technique to bare Descemet's membrane in anterior lamellar keratoplasty [J].
Anwar, M ;
Teichmann, KD .
JOURNAL OF CATARACT AND REFRACTIVE SURGERY, 2002, 28 (03) :398-403
[3]   Spontaneous Corneal Clearance Despite Graft Detachment in Descemet Membrane Endothelial Keratoplasty [J].
Balachandran, Chandra ;
Ham, Lisanne ;
Verschoor, Christianne A. ;
Ong, T. San ;
Van Der Wees, Jacqueline ;
Melles, Gerrit R. J. .
AMERICAN JOURNAL OF OPHTHALMOLOGY, 2009, 148 (02) :227-234
[4]   Risk factors for endothelial cell loss post-keratoplasty [J].
Bertelmann, Eckart ;
Pleyer, Uwe ;
Rieck, Peter .
ACTA OPHTHALMOLOGICA SCANDINAVICA, 2006, 84 (06) :766-770
[5]   Cellular changes in transplanted human corneas [J].
Bourne, WM .
CORNEA, 2001, 20 (06) :560-569
[6]   Endothelial keratoplasty: DSEK/DSAEK or DMEK - the thinner the better? [J].
Dapena, Isabel ;
Ham, Lisanne ;
Melles, Gerrit R. J. .
CURRENT OPINION IN OPHTHALMOLOGY, 2009, 20 (04) :299-307
[7]   Impact of the Descemet membrane perforation on surgical outcomes after deep lamellar keratoplasty [J].
Den, Seika ;
Shimmura, Shigeto ;
Tsubota, Kazuo ;
Shimazaki, Jun .
AMERICAN JOURNAL OF OPHTHALMOLOGY, 2007, 143 (05) :750-754
[8]   Recipient Endothelium May Relate to Corneal Clearance in Descemet Membrane Endothelial Transfer [J].
Dirisamer, Martin ;
Yeh, Ru-Yin ;
van Dijk, Korine ;
Ham, Lisanne ;
Dapena, Isabel ;
Melles, Gerrit R. J. .
AMERICAN JOURNAL OF OPHTHALMOLOGY, 2012, 154 (02) :290-296
[9]   Descemet Membrane Endothelial Transfer: "Free-Floating" Donor Descemet Implantation as a Potential Alternative to "Keratoplasty" [J].
Dirisamer, Martin ;
Ham, Lisanne ;
Dapena, Isabel ;
van Dijk, Korine ;
Melles, Gerrit R. J. .
CORNEA, 2012, 31 (02) :194-197
[10]   Descemet's membrane perforation during deep anterior lamellar keratoplasty: Prognosis [J].
Leccisotti, Antonio .
JOURNAL OF CATARACT AND REFRACTIVE SURGERY, 2007, 33 (05) :825-829