Abstract：
OBJECTIVE: To report a challenging Descemet Membrane Endothelial Keratoplasty (DMEK) case, complicated by intraoperative aqueous misdirection and spontaneous anterior chamber fibrin reaction.
METHODS: A 70-year-old female affected by corneal edema due to Fuchs endothelial dystrophy underwent a triple procedure (cataract extraction - IOL implantation - DMEK surgery) in her left eye. This report illustrates the management of the intraoperative complications of aqueous misdirection syndrome and anterior chamber fibrin reaction.
RESULTS: Despite the optimal management of the posterior pressure and the thorough removal of the fibrinous reaction during the case, the DMEK graft was not completely unfolded and centred at the end of the surgical procedure. Nonetheless, the patient showed good long-term anatomical and functional recovery: at the last follow-up (2 years after surgery), central corneal thickness was 526 µm with a best corrected visual acuity of 20/25 and an endothelial cell density of 1112 cell/mm2.
CONCLUSIONS: Early recognition and prompt management of intraoperative aqueous misdirection syndrome and anterior chamber fibrin reaction during DMEK surgery is essential to ensure good functional and anatomical outcomes.
METHODS: A 70-year-old female affected by corneal edema due to Fuchs endothelial dystrophy underwent a triple procedure (cataract extraction - IOL implantation - DMEK surgery) in her left eye. This report illustrates the management of the intraoperative complications of aqueous misdirection syndrome and anterior chamber fibrin reaction.
RESULTS: Despite the optimal management of the posterior pressure and the thorough removal of the fibrinous reaction during the case, the DMEK graft was not completely unfolded and centred at the end of the surgical procedure. Nonetheless, the patient showed good long-term anatomical and functional recovery: at the last follow-up (2 years after surgery), central corneal thickness was 526 µm with a best corrected visual acuity of 20/25 and an endothelial cell density of 1112 cell/mm2.
CONCLUSIONS: Early recognition and prompt management of intraoperative aqueous misdirection syndrome and anterior chamber fibrin reaction during DMEK surgery is essential to ensure good functional and anatomical outcomes.
摘要：
目的：报告一个具有挑战性的Descemet膜内皮移植术（DMEK）病例，并发术中房水误导和自发性前房纤维蛋白反应。
方法：一名70岁女性因Fuchs内皮营养不良导致角膜水肿，左眼接受了三重手术（白内障摘除-人工晶状体植入-DMEK手术）。该报告说明了房水误导综合征和前房纤维蛋白反应的术中并发症的处理。
结果：尽管在病例中对后压进行了最佳管理并彻底消除了纤维蛋白反应，在外科手术结束时,DMEK移植物未完全展开并居中.尽管如此，患者表现出良好的长期解剖和功能恢复：在最后一次随访（手术后2年），中央角膜厚度为526µm,最佳矫正视力为20/25,内皮细胞密度为1112细胞/mm2.
结论：在DMEK手术期间，早期识别和及时处理术中房水误导综合征和前房纤维蛋白反应对于确保良好的功能和解剖结果至关重要。
方法：一名70岁女性因Fuchs内皮营养不良导致角膜水肿，左眼接受了三重手术（白内障摘除-人工晶状体植入-DMEK手术）。该报告说明了房水误导综合征和前房纤维蛋白反应的术中并发症的处理。
结果：尽管在病例中对后压进行了最佳管理并彻底消除了纤维蛋白反应，在外科手术结束时,DMEK移植物未完全展开并居中.尽管如此，患者表现出良好的长期解剖和功能恢复：在最后一次随访（手术后2年），中央角膜厚度为526µm,最佳矫正视力为20/25,内皮细胞密度为1112细胞/mm2.
结论：在DMEK手术期间，早期识别和及时处理术中房水误导综合征和前房纤维蛋白反应对于确保良好的功能和解剖结果至关重要。
