전층각막이식술 후 발생한 데스메막 잔류 1예
A Case of Retained Descemet’s Membrane after Penetrating Keratoplasty
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목적: 전층각막이식술 후 수여자의 데스메막 잔류가 관찰되어 수술적으로 제거하여 각막이식편을 보존하였기에 이를 보고하고자 한다. 증례요약: 64세 남자환자가 40년 전에 발생한 각막혼탁으로 인한 우안의 시력저하를 주소로 내원하였다. 내원 당시 우안 최대교정시력은 안전수동이었으며 전층각막이식술을 시행하였다. 다음날 각막이식편의 뒤쪽으로 데스메막 잔류와 거짓 전방이 관찰되었다. 시력은20/200 이었고 각막이식편의 부종이 약간 있었으나 전방 염증은 관찰되지 않았다. 잔류된 수여자의 데스메막은 1/4씩 봉합을 제거하였는데 잔류된 수여자의 데스메막을 포셉으로 잡아 수술용 가위와 나이프로 절제하여 제거하고 다시 봉합을 해주며 진행하였다. 수술2개월 후 각막이식편은 투명하게 유지되며 전방염증소견은 관찰되지 않았다. 이후 노인성 백내장으로 낭외수정체적출술 및 인공수정체 삽입술을 시행하였다. 각막이식술 1년 후까지 각막이식편은 투명하게 잘 유지되었으며 최대 교정시력은 20/100까지 향상되었다. 결론: 전층각막이식술 후 잔류된 수여자의 데스메막의 경우 주의깊은 외안부 관찰과 수술적 제거가 각막이식편의 보존에 중요할 것으로 생각한다.
Abstract
Purpose: To report a case of retained Descemet’s membrane after penetrating keratoplasty (PKP). Case summary: A 64-year-old man visited our clinic, complaining of visual disturbance and corneal opacity in his right eye 40 years in duration. On the first visit, his best corrected visual acuity was hand movement on the right eye, and he underwent an uneventful PKP. On the postoperative first day, the patient’s visual acuity was 20/200 and slit lamp examination showed a retained Descemet’s membrane and pseudo-chamber behind the corneal graft. The corneal graft was edematous,but no intraocular inflammation was observed. The retained Descemet’s membrane was surgically removed a quarter at a time. Sutures in one quadrant were removed; the retained Descemet’s membrane was lifted with forceps, removed with scissors and knife, and then sutured again. Two months after PKP, the corneal graft remained clear and no intraocular inflammation was observed. An extracapsular cataract extraction (ECCE) was then successfully performed with posterior chamber lens implantation for the senile cataract in his right eye. After the 1-year follow-up, the status of the corneal graft remained clear with a single anterior chamber and best corrected visual acuity improved to 20/100. Conclusions: Careful post-operative slit-lamp examination is considered important for diagnosis of retained Descemet’s membrane after undergoing PKP, and surgical removal can be helpful for maintaining the corneal graft clear.
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