背景：板层角膜移植术对治疗内皮功能障碍引起的角膜水肿有很大影响。微创移植技术，例如Descemet膜内皮角膜移植术（DMEK），有助于降低此类患者进行穿透性角膜移植术的发病率。即便如此,这些是复杂的技术，并非没有并发症，需要大量的外科学习和更苛刻的术后管理经验。
方法：一名患有Fuchs内皮营养不良并接受白内障和DMEK联合手术的89岁女性在干预后24小时表现出主要为下层基质水肿和移植物部分脱离。在磋商中重新冒泡后，4天后，观察到移植物在前房滚动和游离。24小时后，她接受了重新DMEK，并保留了原始移植物，去上皮化以优化可视化。移植物用台盼蓝染色，后基质用空气保护。在眼内操作和气泡下重新植入移植物。手术后24小时,观察到粘附的移植物，间质水肿大大减少。一个月后,病人角膜透明,持续性完全移植物粘连，视力为0.9。
结论：DMEK手术后前房自由滚动的发现构成了最复杂的移植物脱离形式。角膜水肿以及不同眼内结构的排列是这种并发症的手术解决所要考虑的条件。在许多情况下,手术重新定位移植物是可行的，这意味着节省成本，而无需使用新的供体角膜组织。
BACKGROUND: Lamellar keratoplasties have had a great impact in the management of corneal edema due to endothelial dysfunction. Minimally invasive transplant techniques such as Descemet Membrane Endothelial Keratoplasty (DMEK) have helped to reduce the morbidity involved in performing penetrating keratoplasty in this type of patient. Even so, these are complex techniques that are not free of complications and require a long line of surgical learning and an even more demanding experience in postoperative management.
METHODS: An 89-year-old woman suffering from Fuchs endothelial dystrophy and undergoing combined cataract and DMEK surgery presented stromal edema predominantly inferior and sectoral detachment of the graft 24 h after the intervention. After re-bubbling in consultations and 4 days later, the graft was observed rolled and free in the anterior chamber. She underwent re-DMEK with preservation of the original graft after 24 h, with de-epithelialization to optimize visualization. The graft was stained with trypan blue and the posterior stroma was protected with air. The graft was reimplanted under intraocular maneuvers and with an air bubble. 24 h after surgery, the adhered graft was observed, with a great decrease in stromal edema. One month later, the patient had a clear cornea, persistent complete graft adhesion, and visual acuity of 0.9.
CONCLUSIONS: The discovery of free roll in the anterior chamber after DMEK surgery constitutes the most complex form of graft detachment. Corneal edema as well as the arrangement of the different intraocular structures are conditions to be considered for the surgical resolution of this complication. In many cases, surgical repositioning of the graft is feasible, which means saving costs without the need to use new donor corneal tissues.
