이전 이식편 후부각막실질 전체가 남은 상태에서 시행된 이차 데스메막박리내피각막이식술
Secondary Descemet Stripping Automated Endothelial Keratoplasty without Removing the Previously Grafted Posterior Stroma
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목적: 데스메막박리자동내피각막이식(descemet stripping automated endothelial keratoplasty, DSEAK) 시행 과정 중 이전 이식된각막편의 제거가 완전하게 되지 않은 채 시행된 DSAEK에서 이식된 공여각막이 잘 유지되었던 증례를 보고하고자 한다. 증례요약: 72세 남자 환자가 우안 수포각막병증 소견으로 각막이식을 위해 의뢰되었다. 양안 백내장 및 섬유주절제술을 받은 적 있으며, 2년 전 우안 DSEAK 병력이 있었다. DSAEK시 이전에 이식되어 있던 각막이식편을 제거하려고 하였으나, 후부각막실질의 제거가용이하지 않아 이를 남겨둔 채 새로운 공여각막을 전방에 주입한 뒤 무균공기를 주입하여 각막을 유착시켰다. 술 후 6시간 앙와위자세를 유지하였으며, 항생제 및 스테로이드 안약을 점안하면서 경과 관찰하였다. 술 후 3개월의 경과 관찰 기간 동안 각막 투명도는잘 유지되었으며, 각막단층촬영검사상 이식된 각막편은 잘 유착된 상태로 관찰되었다. 결론: 이전 각막이식편의 완전한 제거가 힘들 경우 이전 이식편 후부각막실질을 그대로 둔 채 DSAEK을 시행하더라도 합병증 없이공여각막의 유착을 기대할 수 있을 것으로 사료된다.
Abstract
Purpose: To report well-attached cornea after secondary Descemet’s membrane stripping automated endothelial keratoplasty (DSAEK) without removing the previous graft. Case summary: A 72-year-old man was referred for decreased visual acuity due to bullous keratopathy in the right eye. He had a history of cataract surgery and trabeculectomy in both eyes and primary DSAEK in the right eye 2 years ago. A new DSAEK graft was superimposed onto the previous grafted posterior stroma due to difficulties with primary graft removal. The patient was laid in supine position for 6 hours to facilitate graft attachment. Grafted cornea remained clear and well-attached for 3 months postoperatively. Conclusions: When previous grafts were difficult to remove completely, new graft could be superimposed onto the previously grafted posterior stroma.
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