Lifshitz T, Oshry T
Department of Ophthalmology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Ophthalmic Surg Lasers. 2001 Jul-Aug;32(4):305-7.
Tectonic epikeratoplasty (TEK) is a method in which a corneal button, preserved in glycerin is used as a seal over corneal perforation. The graft is sutured to the recipient sclera, upon the sick melted cornea, with silk sutures, after 360 degree peritomy of the conjunctiva. The graft is left in place for a few weeks, and by that time the cornea is completely healed. We describe our experience in TEK as a method of treatment for selected cases of melted cornea or descemetocele.
We review 12 TEK operations done in our department over the period of 1992 to 1997, and describe the outcome in each case.
The 12 TEK operations included 9 eyes of 9 patients. The patients, 7 males and 2 females, suffered from ocular surface disturbances including indifference to pain syndrome, Steven-Johnson syndrome, dry eye, relapsing herpetic keratitis, post-traumatic corneal thinning, and local anesthetic abuse. Six of the 9 eyes had leaking perforated corneal ulcer, and the remaining 3 had an imminent perforation caused by descemetocele or melting. All the grafts but one fell off the eyes between 10 and 21 days following surgery. In most of the cases the leakage ceased, and a scar sealing the perforation site was observed. One eye had gone through this procedure 3 times, and another eye had gone through it twice. In only 3 cases did the procedure fail to eliminate leakage, and another TEK or urgent penetrating keratoplasty (PKP) was done.
TEK is an available method for saving the integrity of the globe when PKP is not possible. Although it increases corneal vascularity, PKP can be done later under optimal conditions.
构造性表层角膜移植术（TEK）是一种将保存在甘油中的角膜片用作角膜穿孔覆盖物的方法。在结膜进行360度环切术后，将移植物用丝线缝合到患病溶解角膜上方的受体巩膜上。移植物保留在原位几周，到那时角膜已完全愈合。我们描述了我们使用TEK治疗特定的角膜溶解或后弹力层膨出病例的经验。
我们回顾了1992年至1997年期间在我们科室进行的12例TEK手术，并描述了每个病例的结果。
12例TEK手术涉及9名患者的9只眼睛。患者中7名男性，2名女性，患有眼表疾病，包括无痛觉综合征、史蒂文斯-约翰逊综合征、干眼、复发性疱疹性角膜炎、创伤后角膜变薄和局部麻醉药滥用。9只眼中有6只存在角膜溃疡穿孔渗漏，其余3只因后弹力层膨出或溶解而即将穿孔。除1只眼外，所有移植物在术后10至21天内从眼中脱落。在大多数情况下，渗漏停止，观察到穿孔部位有瘢痕封闭。1只眼进行了3次该手术，另1只眼进行了2次。只有3例手术未能消除渗漏，随后进行了另一次TEK或紧急穿透性角膜移植术（PKP）。
当无法进行PKP时，TEK是一种可用于挽救眼球完整性的方法。虽然它会增加角膜血管化，但之后可在最佳条件下进行PKP。
