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首页> 美国卫生研究院文献>GMS Ophthalmology Cases >Corneal clearance and central endothelial cell repopulation despite graft detachment after Descemet membrane endothelial keratoplasty
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Corneal clearance and central endothelial cell repopulation despite graft detachment after Descemet membrane endothelial keratoplasty

机译：Descemet膜内皮角膜移植术后移植物脱落角膜清除率和中央内皮细胞重新分布

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>Objective: Descemet membrane endothelial keratoplasty (DMEK) is the gold standard procedure for treatment of primary corneal endothelial disorders. Graft detachment is a frequent complication of DMEK, which often requires re-operation or re-bubbling. However, several cases of spontaneous corneal clearance despite graft detachment after DMEK have been reported. The underlying mechanisms of this phenomenon are poorly understood. We report three cases of corneal clearance after graft detachment in patients with Fuchs endothelial dystrophy and provide a review of the literature. >Methods: An 81-year-old and a 69-year-old phakic patient as well as a 56-year-old pseudophakic patient with Fuchs endothelial dystrophy underwent Triple-DMEK and DMEK, respectively. All three patients presented postoperatively with blurred vision due to an almost complete detachment of the graft, as shown by slit-lamp photography and anterior segment optical coherence tomography (OCT). >Results: Without additional intervention, gradual corneal clearance and presence of endothelial cells on the posterior recipient’s stroma were observed in all patients three months postoperatively. Increase in endothelial cell density, decrease in central corneal thickness (CCT), recovery of corneal transparency, and improvement of visual acuity were documented in all patients.>Conclusions: Our findings support the theory of corneal clearance after Descemet membrane endothelial transfer (DMET) (“free-floating” donor Descemet graft in the recipient anterior chamber after descemetorhexis). Further understanding on endothelial homeostasis might lead to innovative approaches in handling endothelial disorders.
机译：>目的：Descemet膜内皮角膜移植术（DMEK）是治疗原发性角膜内皮疾病的金标准程序。移植物脱离是DMEK的常见并发症，通常需要重新手术或重新起泡。然而，已经报道了几例自发性角膜清除术，尽管在DMEK术后移植物脱落。这种现象的潜在机制了解甚少。我们报告了三例Fuchs内皮营养不良患者的移植物脱离后角膜清除率，并提供了文献综述。 >方法：分别对Fuchs内皮营养不良的81岁和69岁的晶状体患者和56岁的假晶状体患者进行了三重DMEK和DMEK。由于裂隙灯摄影和前段光学相干断层扫描（OCT）的显示，由于移植物几乎完全脱离，所有三名患者术后均出现视力模糊。 >结果：在术后三个月中，所有患者均观察到逐渐的角膜清除率和后受体基质上的内皮细胞的存在。所有患者均记录到内皮细胞密度增加，中央角膜厚度（CCT）降低，角膜透明性恢复和视力改善。>结论：我们的发现支持Descemet治疗后角膜清除率的理论。膜内皮细胞移植（DMET）（“干漂浮”供体Descemet移植后在干燥前的受体前房中移植）。对内皮稳态的进一步了解可能会导致治疗内皮疾病的创新方法。

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