데스메막각막내피이식술 후 이식편 실패가 온 환자에서의 데스메막각막내피이식술
Repeat Descemet Membrane Endothelial Keratoplasty after Descemet Membrane Endothelial Keratoplasty Graft Failure
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목적: 데스메막내피각막이식술(Descemet membrane endothelial keratoplasty) 시행 후 이식편 실패가 발생한 환자에게 데스메막내피각막이식술을 재시도하여 성공한 경험을 보고하고자 한다. 증례요약: 47세 여자 환자에게 좌안 푹스 각막내피이상증(Fuchs’ endothelial dystrophy) 진단으로 본원에서 좌안 데스메막내피각막이식술을 시행하였다. 특별한 합병증은 없었으나 수술 6주 후 각막부종 및 수포가 발생하여 갈수록 악화되었으며, 시력 또한 감퇴되어 수술 7개월 후 이식편 실패 진단하에 좌안 데스메막내피각막이식술을 다시 시행하였다. 재수술 후 8개월째 특별한 합병증 없이 각막은 투명하며 최대교정시력 0.6 내외로 유지되고 있다. 결론: 데스메막내피각막이식술 시행 후 이식편 실패가 발생한 환자에서 데스메막내피각막이식술을 재시행하였는데, 수술 중 기존의 데스메막은 어렵지 않게 온전히 제거할 수 있었으며 합병증 없이 성공적인 결과를 얻을 수 있었다.
Abstract
Purpose: To report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) for graft failure after primary DMEK. Case summary: A 47-year-old female underwent primary DMEK in her left eye with a diagnosis of Fuchs’ endothelial dystrophy. At 6 weeks later, corneal stromal edema with epithelial and subepithelial bullae was first observed. From that point on, the condition of the cornea and the visual acuity continued to degrade. After 7 months, a second DMEK procedure (i.e., a repeat DMEK) for graft failure was performed successfully without any complications. Since the second procedure, the cornea has been clear, and the best-corrected visual acuity has remained at 0.6 for 8 months. Conclusions: To manage graft failure after primary DMEK, we performed a second DMEK procedure. The removal of the previous graft was easy, and there were no complications. Thus, repeat DMEK may be a feasible procedure.
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