Soong H K, Farjo A A, Katz D, Meyer R F, Sugar A
W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor 48105, USA.
Cornea. 2000 Mar;19(2):126-34. doi: 10.1097/00003226-200003000-00002.
To evaluate the clinical indications and results of reconstructive (tectonic) lamellar keratoplasty in corneal melting.
A nonrandomized, uncontrolled retrospective case series of 64 consecutive patients (80 eyes) who underwent lamellar keratoplasty for corneal melting at our institution over a 17-year period. We reviewed the (a) clinical indications, (b) visual acuities, (c) postoperative corneal clarity, and (d) post-operative complications. Comparisons in visual acuity were made between central and peripheral corneal melts. The statistical influence of patient age, diagnosis, and corneal graft size on pre- and postoperative visual acuity values also was studied.
Although reconstructive lamellar keratoplasty for active corneal melting was effective in saving the integrity of the globes in all but four patients, the postoperative visual acuity remained poor in the majority of cases because of the often devastating nature of the underlying ocular diseases. Only 14 patients had best postoperative visual acuities of 20/100 or better. Repeated lamellar keratoplasties were necessitated by corneal opacification, infection, or progressive postoperative corneal dissolution in 14 cases. Subsequent vision-restoring surgeries, consisting of penetrating keratoplasties or cataract extractions, were done in 11 eyes with modest improvement of visual acuity. Postoperative visual acuity was significantly better in peripheral corneal melts than in central melts (p = 0.004).
Lamellar keratoplasty is an effective method of restoring the integrity of the eye ravaged by corneal melting. It is less invasive and consequently safer than penetrating keratoplasty in actively inflamed and unstable eyes. The primary purpose for this surgery is to salvage the integrity of the globe during the acute phase of disease and not so much to achieve visual improvement per se. It allows time for systemic immunosuppression to take effect and for the eye to quiet down before possible future vision-restoring surgery.
评估重建性（结构性）板层角膜移植术治疗角膜融解的临床适应证及效果。
对我院17年间连续64例（80只眼）因角膜融解接受板层角膜移植术的患者进行非随机、无对照的回顾性病例系列研究。我们回顾了（a）临床适应证、（b）视力、（c）术后角膜清晰度及（d）术后并发症。比较了中央角膜融解和周边角膜融解患者的视力。还研究了患者年龄、诊断及角膜植片大小对术前和术后视力值的统计学影响。
尽管对于活动性角膜融解行重建性板层角膜移植术除4例患者外对挽救眼球完整性均有效，但由于潜在眼部疾病往往具有破坏性，大多数病例术后视力仍较差。仅14例患者术后最佳视力达到20/100或更好。14例患者因角膜混浊、感染或术后角膜进行性溶解而需要再次行板层角膜移植术。对11只眼进行了后续的视力恢复手术，包括穿透性角膜移植术或白内障摘除术，视力有一定改善。周边角膜融解患者术后视力明显优于中央角膜融解患者（p = 0.004）。
板层角膜移植术是恢复因角膜融解而受损眼球完整性的有效方法。在活动性炎症和不稳定的眼中，它比穿透性角膜移植术侵入性小，因而更安全。该手术的主要目的是在疾病急性期挽救眼球的完整性，而非主要为了提高视力本身。它为全身免疫抑制起效以及眼睛在未来可能的视力恢复手术前恢复平静争取了时间。
