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Descemet membrane endothelial keratoplasty using ophthalmic viscoelastic devices for eyes with laser iridotomy-induced corneal endothelial decompensation

机译：眼虹膜切开术引起的角膜内皮代偿失调的眼科粘弹性装置对眼球的前皮膜内皮角膜移植术

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摘要

Graft insertion into the anterior chamber is one of the most important procedures for successful Descemet membrane endothelial keratoplasty (DMEK). Especially in eyes with fragile zonular fibers and a shallow anterior chamber, smooth graft insertion tends to become more difficult. Ophthalmic viscoelastic devices (OVDs) can usually help to retain the space in the anterior chamber and to improve the safety of manipulations during various ophthalmic surgeries. Therefore, we postulated that graft insertion into the anterior chamber could be improved by their use. The purpose of this study is to investigate the availability and efficacy of OVDs during graft insertion in DMEK surgery.A total of 11 eyes of 9 patients with bullous keratopathy who underwent DMEK were retrospectively analyzed. The cause of bullous keratopathy was corneal endothelial decompensation following laser iridotomy in all eyes. We used low viscous dispersive OVD (Opegan) to maintain the anterior chamber depth during graft insertion in all of the eyes.The graft insertion was uneventful in all of the eyes. The inserted graft was attached to the back surface of the cornea. However, 2 eyes needed rebubbling, and after rebubbling, all of the 2 grafts completely attached to the back surface of the cornea. The best spectacle-corrected visual acuity significantly improved 6 months after surgery (P < .001) and the central corneal thickness significantly decreased (P < .001).The use of OVD facilitates safer graft insertion during DMEK, and subsequently prevents endothelial cell loss, which leads to a successful procedure.
机译：移植物插入前房是成功进行Descemet膜内皮角膜移植术（DMEK）的最重要程序之一。特别是在具有脆弱的小带状纤维和浅前房的眼中，平滑的移植物插入变得更加困难。眼科粘弹性装置（OVD）通常可以帮助在前房中保留空间，并提高各种眼科手术期间操作的安全性。因此，我们推测通过使用它们可以改善移植物插入前房的能力。这项研究的目的是调查DMEK手术中植入OVD的有效性和有效性。对9例接受DMEK的大疱性角膜病变患者的11只眼进行回顾性分析。大眼角膜病变的原因是激光虹膜切开术后所有眼睛的角膜内皮失代偿。我们使用低粘度弥散性OVD（Opegan）来在所有眼睛植入过程中保持前房深度。插入的移植物附着在角膜的背面。然而，需要两只眼睛重新起泡，并且在重新起泡之后，所有两个移植物都完全附着在角膜的背面。术后6个月最佳的眼镜矫正视力明显改善（P <.001），中央角膜厚度明显减少（P（<.001）.OVD的使用有助于在DMEK期间更安全地插入移植物，并随后防止内皮细胞丢失，这将导致成功的程序。

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