Use of viscoelastic substance for preventing Descemet’s membrane rupture in deep anterior lamellar keratoplasty

ABSTRACT Purpose: This study aimed to investigate the effect of using a viscoelastic substance in Descemet’s membrane rupture in “double bubble” deep anterior lamellar keratoplasty. Methods: The medical records and videos of surgeries of 40 patients who underwent surgery between January 2014 and July 2015 were retrospectively evaluated. The patients were divided into two groups: 20 patients whose perforation of the posterior stromal wall was performed without administration of any viscoelastic substance (group 1) and 20 patients whose perforation of the posterior stromal wall was performed with administration of viscoelastic substance onto the posterior stroma (group 2). The Descemet’s membrane perforation rate was compared between groups. Results: Perforation of the Descemet’s membrane was observed in 12 (60.0%) patients in group 1 and only three (15.0%) patients in group 2. This difference was statistically significant (p=0.003). Only one (5%) patient in group 2 had macroperforation during the procedure, and the surgery was converted to penetrating keratoplasty. Eleven (55.0%) patients in group 1 had macroperforation of Descemet’s membrane, and surgeries were converted to penetrating keratoplasty. This difference between the groups was statistically significant (p=0.001). Conclusions: Administering a viscoelastic substance onto the posterior stromal side just before puncture is an effective method to decrease the risk of Descemet’s membrane perforation in deep anterior lamellar keratoplasty.

摘要
研究目的：本研究旨在探讨在“双泡”式深板层角膜移植术（deep anterior lamellar keratoplasty）中，于后弹力层（Descemet’s membrane）破裂时使用粘弹剂（viscoelastic substance）的效果。
研究方法：对2014年1月至2015年7月间接受手术的40例患者的手术病历及手术录像进行回顾性分析。将患者分为两组：组1（20例）为术中后基质层穿孔操作未使用任何粘弹剂者，组2（20例）为术中于后基质表面应用粘弹剂后行后基质层穿孔操作的患者。比较两组的后弹力层穿孔发生率。
研究结果：组1中有12例（60.0%）患者出现后弹力层穿孔，组2仅3例（15.0%），差异具有统计学意义（p=0.003）。组2中仅1例（5.0%）患者术中出现大穿孔（macroperforation），遂改行穿透性角膜移植术（penetrating keratoplasty）；组1中有11例（55.0%）患者出现后弹力层大穿孔，均改行穿透性角膜移植术，两组间该差异具有统计学意义（p=0.001）。
研究结论：在深板层角膜移植术中，于穿孔操作前即刻于后基质侧应用粘弹剂，可有效降低后弹力层穿孔风险。