Клинический случай дезадаптации роговичного рубца у пациента с наличием трансплантированной роговицы после передней послойной кератопластики

Abstract

Purpose. Demonstration of a clinical case of corneal scar edges disadaptation after removal of sutures in anterior deep layered keratoplasty, assessment of patient's treatment. Material and methods. Patient K., 47 years old, underwent deep anterior lamellar keratoplasty in the right eye for stage 3 keratoconus. The operation went as it planned with no complications. At the time of discharge, maximum corrected visual acuity OD was 0.1 n/c. A year later, the suture was removed from the cornea. 3 instillations of okomistin 0.01 % and dexpanthenol 5 % was prescribed to the patient for 12 days. The next day after the removal of sutures, the patient felt a sharp deterioration in vision, redness of the right eye appeared. In a polyclinic at the place of residence, a divergence of corneal scar edges was detected, lasting from 7 to 12 hours, swelling of the graft and reduction of the anterior chamber. The patient was urgently sent to the eye department of the clinic at the place of residence. There, 7 single sutures were urgently applied to fix the graft. In our clinic, to eliminate the corneal wound edges disadaptation, a circular continuous 10\0 suture was applied. In addition, to stop the detachment of the Descemet's membrane (DM), additional air was injected into the anterior chamber. Results. As a result of the treatment, a complete adaptation of corneal wound edges was achieved, the transparency of the graft was restored due to complete adherence of DM to the corneal stroma. The presence of this complication was probably associated with local disturbances in the reparative processes of the cornea, which led to the formation of zones of inadequate scarring. Conclusion. To prevent disadaptation of the corneal wound after keratoplasty, it is necessary to search for objective criteria for quality of the corneal scar and the optimal timing for removal of the corneal suture. Keywords: disadaptation of the corneal scar; corneal transplant; keratoplasty