DMEK开展初期术中及术后并发症的分析及处理

Descemet membrane endothelial keratoplasty in initial cases:analysis and management of surgical complications

目的分析初期开展角膜后弹力层内皮移植术(DMEK)的术中及术后并发症发生的原因及处理的方法。方法回顾性病例研究。纳入2017年2月至2019年12月在北京大学第三医院眼科中心接受DMEK的患者52例(52只眼),其中男性17例,女性35例,年龄(66±12)岁。对所有患者的基本情况、全身及眼部既往病史、术前及术后的裂隙灯检查结果、术中相关内容及术后并发症情况进行分析。结果术中并发症包括植片展开困难6例(11.5%),植片翻转5例(9.6%),植片由切口冲出2例(3.8%),植片推注至虹膜后方3例(5.8%)及术中出血1例(1.9%)。最多见的术后并发症为植片部分脱位,共28例(53.8%),因植片脱位而再注气者25例(48.1%);瞳孔阻滞9例(17.3%),均通过裂隙灯显微镜下前房穿刺放气解除;原发性植片功能失代偿3例(5.8%),术后病毒感染2例(3.8%)。结论开展DMEK初期,并发症发生率高于角膜后弹力层剥除自动角膜内皮移植术。植片翻转是DMEK术中最常见的并发症,植片脱位是术后早期最常见的并发症;适应证的选择、术中及术后的判断和及时处理对于降低并发症发生率非常重要。

Objective To investigate causes and management of surgical complications of Descemet membrane endothelial keratoplasty(DMEK)in initial cases.Methods A retrospective study.A total of 52 eyes of 52 patients underwent DMEK by one surgeon in Peking University Third Hospital from February 2017 to December 2019,including 17 males and 35 females,aged(66±12)years.All patients′demographic characteristics,previous surgical history,intraoperative and postoperative complications were recorded.Results Intraoperative complications included difficulties in unfolding the graft in 6 cases(11.5%),inverted grafts in 5 cases(9.6%),grafts rushing out of the anterior chamber in 2 cases(3.8%),grafts injected behind the iris in 3 cases(5.8%)and hemorrhage in 1 case.Partial graft detachment that occurred in 28 cases(53.8%)was the most frequent postoperative complication.Rebubbling was performed in 25 cases(48.1%).Pupillary block occurred in 9 cases(17.3%)and was managed by reducing air under a slit lamp.Primary graft failure occurred in 3 cases(5.8%)and viral infection occurred in 2 cases(3.8%).Conclusions The rate of complications of DMEK in initial cases is higher than that of Descemet stripping automated endothelial keratoplasty.Intraoperative graft inversion and postoperative graft detachment are the most common complications.It is important to select appropriate indications and discover or manage intraoperative and postoperative complications in time to reduce the incidence of complications。