结论:一些患者在Descemet剥离自动内皮角膜移植术后显示较差的视力结果。在这种情况下,可以进行二次Descemet膜内皮角膜移植术以实现完全的视力恢复。前段光学相干断层扫描(AS-OCT)是后板层角膜移植术结果和并发症随访的有价值的工具。
目的:本研究旨在报告二次Descemet膜内皮角膜移植术的临床结果,以管理先前的Descemet剥离自动内皮角膜移植术后移植失败的患者的视力不良,强调AS-OCT在内皮角膜移植术随访中的重要性。
方法:一名38岁的高度近视女性在植入角度支撑型人工晶状体后,接受了Descemet剥离自动内皮角膜移植术治疗大疱性角膜病变。角膜移植术后两年,患者的视力不佳(数指),临床检查中观察到明显的角膜水肿,阻碍了前房结构的可视化。AS-OCT(Casia2)显示失败且增厚的移植物在前房中很好地粘附到受体角膜,没有其他合并症。因此,移除移植物,并用Descemet膜内皮角膜移植术移植物替代,无任何并发症.一年后,通过比较术前和术后的最佳矫正视力来评估临床结果,生物显微镜检查结果,内皮细胞密度,和角膜中央厚度。
结论:AS-OCT是决定所应用的手术技术和内皮角膜移植物术后监测的重要工具。此病例证明了Descemet膜内皮角膜移植术成功治疗了Descemet剥离自动内皮角膜移植术失败,强调AS-OCT在检测移植物脱位和原发性移植物失败等并发症中的重要性。此外,使用AS-OCT测量的角膜厚度可作为移植物失败的关键预测因子,正如在这种情况下观察到的那样。
CONCLUSIONS: Some patients show poor visual outcomes after Descemet stripping automated endothelial keratoplasty. In such cases, secondary Descemet membrane endothelial keratoplasty can be performed to achieve complete visual recovery. Anterior segment optical coherence tomography (AS-OCT) is a valuable tool for the follow-up of posterior lamellar keratoplasty outcomes and complications.
OBJECTIVE: This study aimed to report the clinical outcome of secondary Descemet membrane endothelial keratoplasty for managing poor visual results in a patient with graft failure after a previous Descemet stripping automated endothelial keratoplasty, highlighting the importance of AS-OCT in the follow-up of endothelial keratoplasty.
METHODS: A 38-year-old woman with high myopia underwent Descemet stripping automated endothelial keratoplasty for bullous keratopathy after explantation of an angle-supported phakic intraocular lens. Two years after keratoplasty, the patient experienced poor visual acuity (counting fingers), and significant corneal edema was observed on clinical examination hindering visualization of the anterior chamber structures. Anterior segment optical coherence tomography showed a failed and thickened graft adhering well to the recipient cornea in an anterior chamber without other comorbidities. Therefore, the graft was removed and replaced with a Descemet membrane endothelial keratoplasty graft without any complications. One year later, the clinical outcome was evaluated by comparing the pre-operative and post-operative best-corrected visual acuity, biomicroscopy findings, endothelial cell density, and corneal central thickness.
CONCLUSIONS: Anterior segment optical coherence tomography is an important tool when deciding on the surgical technique to be applied and for the post-surgical monitoring of endothelial corneal grafts. This
case demonstrates the successful management of Descemet stripping automated endothelial keratoplasty graft failure with Descemet membrane endothelial keratoplasty graft, highlighting the importance of AS-OCT in detecting complications such as graft dislocation and primary graft failure. In addition, corneal thickness measured using AS-OCT serves as a critical predictor of graft failure, as observed in this
case.