白内障手术致角膜后弹力层脱离的诊断与处理

Diagnosis and Management of Descemet membrane detachment after cataract surgery

角膜后弹力层脱离是一种发生率小但可致盲的眼内手术并发症，其高危因素主要包括解剖结构的特殊性、手术操作的刺激、术中灌注液或黏弹剂的错误使用、手术器械不达标或重复使用，以及术者操作欠娴熟等。早期诊断与及时治疗对预后具有关键意义。主要治疗策略包括保守治疗、前房气体填塞、前房注射黏弹剂、手法复位、缝合、后弹力层置换及穿透性角膜移植等。本文对白内障术后角膜后弹力层脱离的临床特点、发生原因、治疗方法等进行综述。

Descemet membrane detachment （DMD） is an uncommon but potentially serious complication of intraocular surgeries such as cataract surgery. The high risk factors of DMD includes particularity of anatomical structures, surgical stimulation, irrigation/ aspiration and viscoelastic material factors, suboptimal instruments, and poor skilled surgeon. Management options for this surgical complication include conservative treatment, hypertonic saline with topical steroids, transcorneal suturing, pneumatic descemetopexy （ intracameral injection of air or another gas）, intracameral injection of viscoelastic material , endothelial or penetrating keratoplasty. Diagnosis and appropriate treatment at early stage is critical for prognosis. In this paper, a systematic review of published trials was conducted to discuss the causes and therapeutic measures of Descemet membrane detachment after cataract surgery.