American journal of ophthalmology · 2011
Transcorneal suture fixation of posterior lamellar grafts in eyes with minimal or absent iris-lens diaphragm.
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Patel Amit K, Luccarelli Saverio, Ponzin Diego, Busin Massimo
Аннотация
PURPOSE: To describe a technique that uses a transcorneal suture for safe delivery and fixation of donor tissue during Descemet stripping automated endothelial keratoplasty in patients that are at risk of graft dislocation into the vitreous cavity as a result of minimal or absent iris-lens diaphragm.
DESIGN: Interventional case series.
METHODS: Thirteen eyes with endothelial decompensation and inadequate iris-lens diaphragm underwent modified Descemet stripping automated endothelial keratoplasty surgery. A 10-0 Prolene suture (Ethicon Inc) was passed through the endothelial graft and used to pull the graft into the eye and anchor it onto the recipient cornea. Best-corrected visual acuity, refraction, and complications were recorded.
RESULTS: Preoperative best-corrected visual acuity was less than 20/200 in all cases. Eleven patients had a pre-existing comorbidity (glaucoma, n = 8; previous retinal detachment, n = 2; epiretinal membrane n = 1). Average follow-up was 11.3 months (range, 3 to 36 months). No graft dislocation occurred during surgery. After surgery, graft detachment was noted in 2 cases and rebubbling succeeded in achieving reattachment. All patients had successful attachment of the endothelial graft. Postoperative best-corrected visual acuity improved in 11 of 13 patients and remained unchanged in 2 patients.
CONCLUSIONS: In patients with insufficient iris-lens diaphragm, this technique allowed safe graft delivery, prevented intraoperative and postoperative graft dislocation, and facilitated successful rebubbling in case of postoperative graft detachment.
DESIGN: Interventional case series.
METHODS: Thirteen eyes with endothelial decompensation and inadequate iris-lens diaphragm underwent modified Descemet stripping automated endothelial keratoplasty surgery. A 10-0 Prolene suture (Ethicon Inc) was passed through the endothelial graft and used to pull the graft into the eye and anchor it onto the recipient cornea. Best-corrected visual acuity, refraction, and complications were recorded.
RESULTS: Preoperative best-corrected visual acuity was less than 20/200 in all cases. Eleven patients had a pre-existing comorbidity (glaucoma, n = 8; previous retinal detachment, n = 2; epiretinal membrane n = 1). Average follow-up was 11.3 months (range, 3 to 36 months). No graft dislocation occurred during surgery. After surgery, graft detachment was noted in 2 cases and rebubbling succeeded in achieving reattachment. All patients had successful attachment of the endothelial graft. Postoperative best-corrected visual acuity improved in 11 of 13 patients and remained unchanged in 2 patients.
CONCLUSIONS: In patients with insufficient iris-lens diaphragm, this technique allowed safe graft delivery, prevented intraoperative and postoperative graft dislocation, and facilitated successful rebubbling in case of postoperative graft detachment.