Akova Y A, Dabil H, Kavalcioglu O, Duman S
Department of Ophthalmology, Baskent University Hospitals, Ankara, Turkey.
Ocul Immunol Inflamm. 2000 Jun;8(2):101-9.
Acute hydrops develops when Descemet's membrane and the endothelium of the ectatic cornea separates to allow aqueous humor to enter the stroma. The current study was done to determine if penetrating keratoplasty (PK) in keratoconus patients with resolved hydrops has a poor prognosis.
A retrospective chart review of 35 eyes of 35 patients with keratoconus who underwent PK after the resolution of acute hydrops (Group 1) and of 74 eyes of 69 patients who had PK without a previous history of acute hydrops (Group 2) was performed. The chi-square test was used for statistical analysis.
The mean age in Group 1 was 21.1+/-11. 0 years. The mean age in Group 2 was 23.2+/-14.4 years. Vernal keratoconjunctivitis was present in 11 patients in Group 1 (31%) and in 12 (17.4%) patients in Group 2. Loose sutures were present in two patients (6%) in Group 1; both resulted in loose suture-related corneal neovascularization. Loose sutures developed in five patients (7%) in Group 2. In Group 1, three patients (9%) had microbial keratitis. Microbial keratitis was seen in five patients (7%) in Group 2. Two patients (6%) in Group 1 developed late endothelial graft failure. In Group 2, one eye (1%) developed early and one eye (1%) late epithelial graft rejection; five eyes (7%) developed late endothelial graft rejection. There was no statistically significant difference between the two groups with respect to the incidence of graft rejection. At the last examination, 34 eyes in Group 1 had clear grafts; in the second group, graft clarity was achieved in 71 eyes.
Penetrating keratoplasty in hydrops is successful in terms of graft clarity and visual outcome in patients with keratoconus after the resolution of hydrops. The patients should have preoperative and postoperative anti-allergic treatment and close follow-up for possible complications.
当后弹力层和扩张角膜的内皮分离，使房水进入基质时，急性角膜水肿就会发生。本研究旨在确定圆锥角膜患者急性角膜水肿消退后行穿透性角膜移植术（PK）的预后是否不良。
对35例急性角膜水肿消退后行PK的圆锥角膜患者的35只眼（第1组）和69例无急性角膜水肿病史而行PK的69例患者的74只眼（第2组）进行回顾性病历审查。采用卡方检验进行统计学分析。
第1组的平均年龄为21.1±11.0岁。第2组的平均年龄为23.2±14.4岁。第1组11例患者（31%）有春季角结膜炎，第2组12例患者（17.4%）有春季角结膜炎。第1组2例患者（6%）有缝线松解；均导致缝线相关角膜新生血管形成。第2组5例患者（7%）出现缝线松解。第1组3例患者（9%）发生细菌性角膜炎。第2组5例患者（7%）发生细菌性角膜炎。第1组2例患者（6%）发生晚期内皮植片失败。第2组1只眼（1%）发生早期和1只眼（1%）发生晚期上皮植片排斥反应；5只眼（7%）发生晚期内皮植片排斥反应。两组在植片排斥反应发生率方面无统计学显著差异。在最后一次检查时，第1组34只眼植片透明；在第2组，71只眼实现了植片透明。
对于圆锥角膜患者，角膜水肿消退后行穿透性角膜移植术在植片透明性和视觉效果方面是成功的。患者术前和术后应进行抗过敏治疗，并密切随访以预防可能的并发症。
