Russian MedicineRussian MedicineРоссийский медицинский журнал0869-21062412-9100Eco-Vector3844510.18821/0869-2106-2018-24-3-129-134ArticlesСтатьиResearch ArticleTHE TRANSPLANTATION OF DESCEMET’S MEMBRANE WITH ENDOTHELIUM IN COMPLICATED CLINICAL SITUATIONSТРАНСПЛАНТАЦИЯ ДЕСЦЕМЕТОВОЙ МЕМБРАНЫ С ЭНДОТЕЛИЕМ В ОСЛОЖНЁННЫХ КЛИНИЧЕСКИХ СИТУАЦИЯХOganesyanOganes G.ОганесянОганес Георгиевич

doctor of medical sciences, senior researcher of the Department of Traumatology and Reconstructive Surgery «The Helmholtz Moscow Research Institute of Eyes Diseases», 105062, Moscow, Russian Federation

доктор мед. наук, ст. научный сотрудник отдела травматологии и реконструктивной хирургии ФГБУ «Московский научно-исследовательский институт глазных болезней им. Гельмгольца» Минздрава России

oftalmolog@mail.ruMakarovP. VМакаровП. ВGrdikanyanA. AГрдиканянА. АGetadaryanV. RГетадарянВ. Р«The Helmholtz Moscow Research Institute of Eyes Diseases» of the Ministry of Health of the Russian FederationФГБУ «Московский научно-исследовательский институт глазных болезней им. Гельмгольца» Минздрава России15062018243VOL 24, NO3 (2018)ТОМ 24, №3 (2018)12913421072020Copyright ©; 2018, Eco-VectorCopyright ©; 2018, ООО "Эко-Вектор"2018Eco-VectorООО "Эко-Вектор"https://medjrf.com/0869-2106/article/view/38445

The transplantation of Descemet's membrane with endothelium (DMEK) is the most efficient method of treatment of endothelium pathology. However, it is considered that at certain clinical situations DMEK is inappropriate. The purpose of study is to analyze the results of DMEK in complicated clinical situations. Materials and methods. The sampling included 14 patients (16 eyes) with pathology of endothelium of primary (19%) and secondary (81%) genesis and with concomitant alterations, including: total lack of vitreous (19%), non-posterior chamber pseudophakia (25%), presence of Ahmed drainage (25%), artificial lensiris diaphragm (12%), corneal ectasia combined with toric artiphakia (12%), penetrating scar of cornea (6%). Prior to operation, average visual acuity amounted to 0,04±0,05. The subtotal DMEK was applied to 15 eyes and in one case ¼ DMEK was implemented. In 2 cases cornea of donor had keratotomic incisions and in one case Descemetotransplant was formed from residual back layers of cornea after formation of front layer wise transplant using femtosecond laser. The results. No intra-operational complications were established. In 19% of cases a partial mismatch of transplant took place. The repeated DMEK was implemented in 1 case. The recovery of transparency of cornea and increasing of vision acuity were achieved in 94% of cases. In 6 months after operation an average central thickness of cornea amounted to 522±46 μm and density of endothelium cells in average amounted to 1541±486 kl/mm2. Conclusion. The application of DMEK in complicated situations ensures high biological and functional results and is accompanied with minimal number of complications. The procurement of expertise in endothelium surgery, it is appropriate to apply DMEK in all cases of pathology of endothelium.

Трансплантация десцеметовой мембраны с эндотелием (DMEK) является наиболее эффективной методикой лечения эндотелиальной патологии. Однако считается, что при некоторых клинических ситуация DMEK нецелесообразна. Цель работы - анализ результатов DMEK в осложнённых клинических ситуациях. Материал и методы. В исследование включили 14 пациентов (16 глаз) c патологией эндотелия первичного (19%) и вторичного (81%) генеза и с сопутствующими изменениями, в том числе: тотальная авитрия (19%), незаднекамерная артифакия (25%), присутствие дренажа Ахмеда (25%) артииридофакия (12%), кератэктазия в сочетании с торической артифакией (12%), приникающий рубец роговицы (6%). До операции средняя острота зрения составила 0,04 ± 0,05. На 15 глазах выполнена субтотальная DMEK, в 1 случае выполнена ¼ DMEK. В 2 случаях роговица донора имела кератотомические насечки, еще в 1 случае десцеметотрансплантат сформирован из остаточных задних слоёв роговицы после формирования переднего послойного трансплантата с помощью фемтосекундного лазера. Результаты. Интраоперационных осложнений не зафиксировано. В 19% случаев имело место частичное неприлегание трансплантата. Повторная DMEK выполнена в 1 случае. Восстановление прозрачности роговицы и повышение остроты зрения достигнуты в 94% случаев. Спустя 6 мес после операции средняя центральная толщина роговицы составила 522 ± 46 мкм, а плотность эндотелиальных клеток в среднем 1541 ± 486 кл/мм2. Заключение. Выполнение DMEK в осложнённых ситуациях обеспечивает высокие биологические и функциональные результаты и сопровождается минимальным количеством осложнений. С приобретением опыта эндотелиальной хирургии целесообразно выполнение DMEK во всех случаях патологии эндотелия.

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