전층각막이식술 후 이식편 실패가 온 환자에서의 데스메막내피각막이식술
Descemet Membrane Endothelial Keratoplasty after Penetrating Keratoplasty Graft Failure
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목적: 전층각막이식술(penetrating keratoplasty) 후 이식편 실패가 온 환자에게 이차적으로 데스메막내피각막이식술(Descemet membrane endothelial keratoplasty, DMEK)을 성공적으로 시행한 1례를 보고하고자 한다. 증례요약: 46세 남자 환자는 양안 원추각막으로 30년 전 우안 전층각막이식술, 14년 전 좌안 전층각막이식술을 받고 경과 관찰하던 중 1년 6개월 전부터 좌안 이식편 실패로 좌안 시력이 서서히 감소하였다. 좌안 이식편 실패에 대해 이차 각막이식술로 데스메막내피각막이식술을 시행하였다. 수술 후 13일째 각막 비측 1/4의 이식편이 분리되어 있는 것이 발견되어 1차례 추가적인 공기주입술을 시행하였다. 수술 후 8달째 환자는 나안시력 0.5까지 확인되었으며 각막은 투명한 상태로 이식편 거부반응 없이 잘 유지되고 있다. 결론: 전층각막이식술 후 이식편 실패가 온 환자에서 이차적인 각막이식술로 데스메막내피각막이식술을 성공적으로 시행하였고 결과도 양호하였다.
Abstract
Purpose: To report a case of a successful secondary Descemet membrane endothelial keratoplasty in failed penetrating keratoplasty. Case summary: A 46-year-old male with keratoconus in both of his eyes underwent penetrating keratoplasty in his right eye 30 years ago and in his left eye 14 years ago. From one and a half year ago, the patient’s visual acuity decreased in his left eye due to graft failure. For treatment, secondary Descemet membrane endothelial keratoplasty was performed. Partial detachment of Descemet membrane was observed at 13 days after the operation, and an additional air injection was performed. At 8 months after the operation, the patient’s uncorrected visual acuity improved to 0.5 and the cornea maintained its clearance without rejection. Conclusions: Secondary Descemet membrane endothelial keratoplasty was successfully performed in a patient with failed penetrating keratoplasty.
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