FIELD: medicine; ophthalmology.
SUBSTANCE: transplantation of the endothelium on the Descemet's membrane is carried out in case of endothelial dysfunction of the cornea with a violation of the integrity of the iridolenticular diaphragm. Using a femtosecond laser, a bandage stromal flap (BSF) is formed from the outer layers of the donor corneoscleral disk with a diameter of 2 mm less than the minimum linear size of the anterior chamber of the recipient's eye along the horizontal or vertical meridian determined during preoperative diagnostics, and 200 μm thick. The resulting BSF is folded in half and implanted into the anterior chamber of the eye so that the BSF Bowman's membrane is oriented toward the posterior surface of the recipient's cornea. Then, a donor graft of Descemet's membrane with a layer of endothelium is implanted into the space between the posterior surface of the recipient's cornea and the BSF. After straightening and positioning of the Descemet's membrane graft with a layer of endothelium in the area of descemetorhexis, under the control of intraoperative optical coherence tomography (OCT) in the space between the endothelial graft and BSF, air tamponade of the anterior chamber of the eye is performed. In the postoperative period, BSF is removed from the anterior chamber of the eye after resorption of the air bladder and complete adhesion of the Descemet's membrane graft with the endothelial layer to the posterior surface of the recipient's cornea.
EFFECT: method makes it possible to close the existing defects of the iridolenticular diaphragm with a bandage scleral flap, without the risk of migration of the Descemet's membrane graft with an endothelial layer, to obtain the possibility of a full-fledged long-term pneumopexy of the Descemet's membrane graft with an endothelial layer to the recipient's own stroma, without migration of air or gas-air mixture into the vitreous cavity, to carry out high-quality graft adhesion without the risk of maladaptation of the Descemet's membrane graft with a layer of endothelium relative to the posterior surface of the recipient's cornea and without the need for re-introduction of air or air-gas mixture into the anterior chamber of the eye in the early postoperative period.
1 cl, 1 ex
