Johnston R H, Nguyen R, Jongsareejit A, Lee B R, Patel S, Chong L P
Doheny Eye Institute, Department of Ophthalmology, University of Southern California School of Medicine, Los Angeles, USA.
Retina. 1999;19(2):116-21. doi: 10.1097/00006982-199902000-00005.
To assess the effectiveness of a combined procedure (pars plana vitrectomy with temporary keratoprosthesis, penetrating keratoplasty, and pars plana seton implant) in preserving vision and controlling intraocular pressure (IOP).
We reviewed the course of visual acuity, IOP, graft clarity, retinal status, and complications in 18 patients who underwent the above procedure during one operating sitting.
Preoperative diagnoses were varied. The majority of patients had pseudophakic bullous keratopathy and failed corneal transplants with glaucoma. Preoperative mean visual acuity was hand motions. Preoperative mean IOP was 27+/-13 mm Hg. Initially, all patients had attached retina. With a mean follow-up of 17+/-9 months, six patients had improved vision greater than 2 lines and 10 had unchanged vision. Only two patients lost vision greater than 2 lines. The final average IOP was 16+/-6 mm Hg and only one eye had a pressure above 22 mm Hg. Three eyes were classified as complete failures; two of the three became phthisical. Two patients developed rhegmatogenous detachments requiring further surgery.
The combined procedure offers reasonable improvement in vision, good pressure control, and a tolerable number of complications. It is a useful procedure in eyes that probably would not have been treatable otherwise.
评估一种联合手术（经平坦部玻璃体切除术联合临时角膜移植片、穿透性角膜移植术和平坦部引流物植入术）在保留视力和控制眼压方面的有效性。
我们回顾了18例在一次手术中接受上述手术患者的视力、眼压、植片清晰度、视网膜状况及并发症的病程。
术前诊断各异。大多数患者患有人工晶状体眼大泡性角膜病变及失败的角膜移植合并青光眼。术前平均视力为手动。术前平均眼压为27±13 mmHg。最初，所有患者视网膜均附着。平均随访17±9个月，6例患者视力提高超过2行，10例患者视力无变化。只有2例患者视力下降超过2行。最终平均眼压为16±6 mmHg，只有一只眼眼压高于22 mmHg。3只眼被判定为完全失败；其中2只眼球萎缩。2例患者发生孔源性视网膜脱离，需要进一步手术。
联合手术在视力改善、眼压控制及并发症数量方面效果合理。对于那些原本可能无法治疗的眼睛，该手术是一种有效的方法。
