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Abstract：
UNASSIGNED: To report how to manage a specific type of Descemet\'s membrane (DM) rupture during manual DALK with a concurrent donor-recipient disparity of curvature.
UNASSIGNED: Case report of two patients that had DM rupture during manual DALK with a concurrent donor-recipient disparity of curvature; the recipient bed was flatter (post-infectious scar, case 1) and steeper (keratoglobus, case 2) than the donor. Preoperative diagnosis, clinical exam, and best spectacle correct visual acuity (BSCVA) have been reported. A subtotal full-thickness circular cut of the recipient bed was performed to resolve a persistent double AC in case 1 (recipient flatter than donor). A total full-thickness circular cut of the recipient bed, creating a graft made by a DALK allograft and a \"DSEK autograft,\" was performed to avoid a refractory double AC in case 2 (recipient steeper than donor). Evaluated outcomes included postoperative BSCVA, endothelial cell count (ECC), graft clarity, rejection, and presence/absence of double AC.
UNASSIGNED: Surgery was successful in resolving/avoiding double AC. VA improved in both cases. No episodes of rejection were recorded. Graft remained clear at the last follow-up (6 years for case 1 and 4 years for case 2).
UNASSIGNED: The existence of a donor-recipient curvature disparity should be investigated as a possible underlying mechanism of refractory double AC. Total or subtotal full thickness recipient bed cut may be considered to repair donor-recipient curvature disparity in cases of DM rupture occurring during manual DALK. Repairing the DM rupture and avoiding a conversion to PK in high-risk transplant cases are crucial.
UNASSIGNED: Case report of two patients that had DM rupture during manual DALK with a concurrent donor-recipient disparity of curvature; the recipient bed was flatter (post-infectious scar, case 1) and steeper (keratoglobus, case 2) than the donor. Preoperative diagnosis, clinical exam, and best spectacle correct visual acuity (BSCVA) have been reported. A subtotal full-thickness circular cut of the recipient bed was performed to resolve a persistent double AC in case 1 (recipient flatter than donor). A total full-thickness circular cut of the recipient bed, creating a graft made by a DALK allograft and a \"DSEK autograft,\" was performed to avoid a refractory double AC in case 2 (recipient steeper than donor). Evaluated outcomes included postoperative BSCVA, endothelial cell count (ECC), graft clarity, rejection, and presence/absence of double AC.
UNASSIGNED: Surgery was successful in resolving/avoiding double AC. VA improved in both cases. No episodes of rejection were recorded. Graft remained clear at the last follow-up (6 years for case 1 and 4 years for case 2).
UNASSIGNED: The existence of a donor-recipient curvature disparity should be investigated as a possible underlying mechanism of refractory double AC. Total or subtotal full thickness recipient bed cut may be considered to repair donor-recipient curvature disparity in cases of DM rupture occurring during manual DALK. Repairing the DM rupture and avoiding a conversion to PK in high-risk transplant cases are crucial.
摘要：
■报告如何在手动DALK过程中管理特定类型的Descemet膜（DM）破裂，同时存在供体-受体曲率差异。
■两名患者在手动DALK期间发生DM破裂，同时供者与受者的曲率差异；受者床较平坦（感染后的疤痕，案例1)和更陡(角膜，案例2)比捐赠者。术前诊断,临床检查,和最佳眼镜矫正视力（BSCVA）已被报道。在情况1（接受者比供体更平坦）中，对接受者床进行了小计全厚度圆形切割，以解决持续的双AC。受体床的全厚圆形切口，制作由DALK同种异体移植物和DSEK自体移植物制成的移植物，在情况2（接受者比供体更陡）中，进行了避免难治性双AC。评估结果包括术后BSCVA，内皮细胞计数（ECC），移植物清晰度，拒绝,和双AC的存在/不存在。
■手术成功解决/避免了双AC。两种情况下的VA均得到改善。没有记录到排斥事件。移植在最后一次随访时仍然清晰（病例1为6年，病例2为4年）。
■应研究供体-受体曲率差异的存在，作为难治性双AC的可能潜在机制。在手动DALK期间发生DM破裂的情况下，可以考虑进行总或小全厚度受体床切割以修复供体-受体曲率差异。修复DM破裂并避免在高风险移植病例中转换为PK至关重要。
■两名患者在手动DALK期间发生DM破裂，同时供者与受者的曲率差异；受者床较平坦（感染后的疤痕，案例1)和更陡(角膜，案例2)比捐赠者。术前诊断,临床检查,和最佳眼镜矫正视力（BSCVA）已被报道。在情况1（接受者比供体更平坦）中，对接受者床进行了小计全厚度圆形切割，以解决持续的双AC。受体床的全厚圆形切口，制作由DALK同种异体移植物和DSEK自体移植物制成的移植物，在情况2（接受者比供体更陡）中，进行了避免难治性双AC。评估结果包括术后BSCVA，内皮细胞计数（ECC），移植物清晰度，拒绝,和双AC的存在/不存在。
■手术成功解决/避免了双AC。两种情况下的VA均得到改善。没有记录到排斥事件。移植在最后一次随访时仍然清晰（病例1为6年，病例2为4年）。
■应研究供体-受体曲率差异的存在，作为难治性双AC的可能潜在机制。在手动DALK期间发生DM破裂的情况下，可以考虑进行总或小全厚度受体床切割以修复供体-受体曲率差异。修复DM破裂并避免在高风险移植病例中转换为PK至关重要。
