Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
A Simple Technique to Aid Visualization of the Graft During Descemet Membrane Endothelial Keratoplasty in Complicated Cases
Komplike Olgularda Descemet Membran Endotelyal Keratoplasti Sırasında Greft Görünürlüğünü Arttırmak için Basit Bir Yöntem
Leyla ASENAa, Dilek DURSUN ALTINÖRSa
aDepartment of Ophthalmology, Başkent University Faculty of Medicine, Ankara, TURKEY
Turkiye Klinikleri J Med Sci. 2019;39(3):299-303
doi: 10.5336/medsci.2019-65182
Article Language: EN
Full Text
ABSTRACT
 Objective: To present an alternative illumination technique in patients with clouded or opaque corneas, undergoing Descemet Membrane Endothelial Keratoplasty (DMEK) and to report the clinical outcomes. Material and Methods: Ten cases who underwent DMEK surgery between September 2016 and September 2017 with poor visualization of the anterior chamber due to corneal opacities, were included in the study. Medical records were reviewed retrospectively. Wilcoxon signed-rank test was used to compare pre- and postoperative clinical findings. Results: Six patients had bullous keratopathy and four patients had a previous corneal transplant failure. During graft unfolding and centration, the intensity of the oblique field component of the operating microscope was dimmed and only coaxial illumination was used to enhance the red reflex. This was useful for observation of the correct orientation of the graft and allowed successful graft positioning in all cases. Mean postoperative follow-up duration was 18.3±4.1 months. All patients had increased visual acuity. Mean Snellen best corrected visual acuity increased from 0.08±0.05 to 0.39±0.14 (p=0.16) at the third month and to 0.53±0.09 (p=0.02) at the end of the follow-up. Mean central corneal thickness decreased from 873.4±64.3 μm to 588±39.2 μm (p=0.01). Eight patients (80%) had a clear cornea centrally, at the third month. Two patients underwent penetrating keratoplasty (PK) due to unsatisfactory vision after DMEK. Conclusion: In cases with corneal opacities, retroillumination technique may improve the outcome of DMEK surgery by preventing the formation of an inverted graft. In 20% of these complicated cases, consequent PK may be needed.

Keywords: Clouded cornea; descemet membrane endothelial keratoplasty; graft orientation; retroillumination
ÖZET
 Amaç: Opak veya ileri derecede bulanık korneası olan hastalarda Descemet Membran Endotelyal Keratoplasti (DMEK) sırasında kullanılabilecek alternatif bir illüminasyon tekniğinin tarif edilmesi ve klinik sonuçların bildirilmesi. Gereç ve Yöntemler: Kliniğimizde Eylül 2016 ile Eylül 2017 arasında DMEK cerrahisi uygulanmış, korneal opasite veya bulanıklık nedeni ile cerrahi sırasında ön kamaranın yeterli derecede seçilemediği 10 olgu dahil edilmiştir. Hasta kayıtları retrospektif olarak incelenmiştir. Pre- ve postoperatif klinik bulguların karşılaştırılması için Wilcoxon signed-rank test kullanılmıştır. Bulgular: Altı hastada büllöz keratopati ve 4 hastada geçirilmiş penetran keratoplasti (PK) sonrası greft yetmezliği mevcuttu. Greft açılması ve santralizasyonu sırasında cerrahi mikroskop ışığının oblik bileşeni kısılarak sadece koaksiyel aydınlatma kullanılmış ve bu sayede kırmızı refle yansıması arttırılmıştır. Bu şekilde elde edilen retroillüminasyon sayesinde greftin açılması sırasında greft oryantasyonu daha kolay belirlenebilmiş ve tüm hastalarda greft başarılı bir şekilde yerleştirilebilmiştir. Postoperatif takip süresi ortalama 18,3±4,1 ay olarak belirlenmiştir. Takipte tüm hastalarda görme keskinliğinde artış saptanmıştır. Ortalama Snellen en iyi düzeltilmiş görme keskinliği 0,08±0,05'den, üçüncü ayda 0,39±0,14'e (p=0,16), ve takip sonunda 0,53±0,09'a (p=0,02) yükselmiştir. Ortalama santral kornea kalınlığı 873,4±64,3 μm'den takip sonunda 588±39,2 μm'ye inmiştir (p=0,01). Takip sonunda, 8 hastada (%80) kornea görme aksında saydam idi. Greft yetmezliği nedeniyle DMEK uygulanmış olan 2 hastaya, düşük görme seviyesi nedeni ile PK uygulandı. Sonuç: Kornea opasitesi veya ileri derecede bulanıklığı bulunan hastalarda DMEK cerrahisi sırasında retroillüminasyon tekniğinin kullanılması, cerrahi sırasında ön kamarada greft oryantasyonunun belirlenmesine yardımcı olmakta ve geftin ters yerleştirilme olasılığını düşürmektedir. Bu komplike olguların %20'sinde takipte PK uygulanması gerekebilmektedir.

Anahtar Kelimeler: Bulanık kornea; descemet membran endotelyal keratoplasti; greft oryantasyonu; retroillüminasyon
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