1. DSAEK (Descemet's Stripping Automated Endothelial Keratoplasty)
Case conference
DSAEK (Descemet's Stripping Automated Endothelial Keratoplasty)
R3 이유경/Pf.주천기

2. Case 1 66/F 오O순 C/C: decreased VA(OS>OD) Past Hx Onset) 내원 2년전
DM/HBP (-/-)
Ocular op/trauma(+/-)
2004. ALI(OU) at local
ECCE + PCL (OS)
specular OD/OS 406/313, AL 21.41
Gls (-)
Eye drop (+) : taflotan x hs(OS)

3. Ocular exam VA: OD 0.02 (0.08) OS FC/30cm (n-c) IOP: OD 18
OS 16 mmHg at 7:00 PM by AP
Conj.: not injected(OU)
Cornea: OD mild edematous
OS mod to severe edematous c DM foldings,
diffuse microbullae & macrobullae
AC: <4CT at center &< 1/2 at pph c cell(-)
Pupil: round & normal sized, LR(+/+)
Lens: OD mod nucleosclerosis
OS PCL in situ
(OU)

4. Photospot OS OD

5. Ocular exam
Pachymetry: OD/OS 786/847
Specular: uncheckable

6. Operation Imp) Pseudophakic bullous keratopathy(OS)
Bullous keratopathy(OD)
Px) PPKP or DSaEK(OS)
Phaco+PCL+DSaEK(OD)
DSaEK(OS) by Pf.주천기
Donor trephine: 8mm

7. Post op. F/U POD #1d #4d #10d VA IOP FC/50cm(N-C) 17 mmHg 0.02(N-C)
Conj. : mod. injected,
well approximated Wx.
Cornea : well attached graft,
mod.edematous c DM folding,
AC : deep & cell(+)
air-fluid level 50%
Conj. : mild injected
Cornea : edema( )
DM folding( )
AC : deep & cell(trace)
air-fluid level 5~10%( )
Cornea : edema ( )
DM folding ( )
AC : deep & cell(-)
POD#1d
POD#10d

8. Case 2 80/M 이O무 C/C: decreased VA(OD) Onset) 내원 수개월전 Past Hx
DM/HBP(-/-)
Ocular trauma/op(+/+)
20년전 Cat.op.(OU)
Hammer drill 손잡이에 우안 수상
Primary closure+Iris forced resection dislocated IOL removal+Ant.vitrectomy(OD)
' T-S-F of iris colored IOL+Ant.vitrectomy(OD)

9. Ocular exam VA: OD 0.06 (n-c) OS 1.0 IOP: OD 14
OS 18 mmHg at 2:30 PM by AP
Conj.: not injected(OU)
Cornea: OD mild to mod. edematous c DM foldings
diffuse SPE’s, diffuse endothelial opacity
OS clear
AC: <4CT at center &< 1/2 at pph c cell(-) (OU)
Pupil: OD aniridic state
OS round & normal sized, LR(+/+)
Lens: OD well fixated iris colored IOL
OS well positioned IOL

10. Photospot
Imp) Pseudophakic bullous keratopathy(OD)
Px) DSaEK(OD)

11. Operation Graft failure!! Re-DSaEK
Intralase Enabled DSaEK(OD) by Pf.주천기
- Donor size 8.1mm, flap thickness 100~180um Recipient size 8.5mm, flap thickness 150um
POD#1yr
Graft failure!!
Re-DSaEK

12. Operation 2010.11.8 Intrase Enabled keratoplasty (OD) by Pf.주천기
- Donor size 8.2mm, flap thickness- epithelium으로부터 380um
- Recipient size 8.5mm, flap thickness 100~180um

13. POD#1d B A

14. POD#1d B A
이식한 내피층판 확인할 수 없음

15. POD#1d
유리체내 이식한 내피층판 확인

16. pppV+intraocular endothelial flap removal+conventional PPKP(OD)
POD#1wk