Tanure M A, Cohen E J, Grewal S, Rapuano C J, Laibson P R
Cornea Service, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
Cornea. 2000 Mar;19(2):135-9. doi: 10.1097/00003226-200003000-00003.
To examine and report the results of penetrating keratoplasty performed in patients with varicella-zoster virus keratopathy.
The authors retrospectively reviewed the records of 15 patients who had penetrating keratoplasty for varicella-zoster virus keratopathy from January 1989 through December 1998 on the Cornea Service at Wills Eye Hospital.
Twelve patients had a preoperative diagnosis of herpes zoster ophthalmicus, and three, of varicella. Four eyes had lateral tarsorrhaphies performed in conjunction with penetrating keratoplasty. Three eyes had endothelial rejection episodes that responded well to treatment with topical steroids. One eye had a regraft 1 month after primary failure, and this second graft also failed because of recurrent neurotrophic keratopathy. Three eyes that had repeated penetrating keratoplasty for graft failure had clear grafts at the last examination. At an average follow-up time of 50 months, 13 (86.7%) grafts remained clear, and the best corrected visual acuity was 20/100 or better in eight (53.3%) eyes. Five patients had decreased visual acuity because of retinal diseases.
Although varicella-zoster virus keratopathy is an uncommon indication for penetrating keratoplasty, effective visual rehabilitation can be achieved in these patients. Careful postoperative management, frequent lubrication, and lateral tarsorrhaphies to protect the corneal surface are major factors in the successful outcome of these cases.
检查并报告水痘-带状疱疹病毒角膜病变患者穿透性角膜移植术的结果。
作者回顾性分析了1989年1月至1998年12月在威尔斯眼科医院角膜科因水痘-带状疱疹病毒角膜病变接受穿透性角膜移植术的15例患者的病历。
12例患者术前诊断为眼部带状疱疹，3例为水痘。4只眼在穿透性角膜移植术同时进行了外侧睑裂缝合术。3只眼发生内皮排斥反应，经局部类固醇治疗后反应良好。1只眼在初次手术失败1个月后进行了再次移植，但第二次移植也因复发性神经营养性角膜病变而失败。3只因移植失败而反复进行穿透性角膜移植术的眼睛在最后一次检查时移植片透明。平均随访时间为50个月，13只（86.7%）移植片保持透明，8只（53.3%）眼睛的最佳矫正视力达到20/100或更好。5例患者因视网膜疾病视力下降。
尽管水痘-带状疱疹病毒角膜病变是穿透性角膜移植术的罕见适应证，但这些患者仍可实现有效的视力康复。术后仔细管理、频繁润滑以及外侧睑裂缝合术以保护角膜表面是这些病例成功的主要因素。
