Riedel Tobias, Seitz Berthold, Langenbucher Achim, Naumann Gottfried O H
Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg, Germany.
Klin Monbl Augenheilkd. 2002 Jan-Feb;219(1-2):40-5. doi: 10.1055/s-2002-23499.
The purpose of this study was to asses the functional results of eccentric homologous penetrating keratoplasty in respect of diagnosis as well as position and size of the corneal graft.
In this retrospective study, visual acuity and astigmatism of 117 cases of a round eccentric homologous penetrating keratoplasty in 91 eyes of 91 patients were analysed. The PK became necessary because of a corneal ulcer (104), 6 eyes with corneal scars and 7 eyes with ectatic corneal diseases. Using 84 postoperative slides the following parameters were quantified: graft diameter and transparency, distance of the geometric centre of the cornea from the central trephination margin (distance) as well as from the geometric centre of the graft (decentration). Seventeen grafts were classified as eccentric peripheral keratoplasty (mean diameter 5.0 +/- 1.7 mm) with the optical axis through the host cornea and 67 as eccentric central keratoplasty (7.0 +/- 1.3 mm) with the optical axis through the graft.
The average follow-up period was 25 months. The astigmatism after 3/12/24 months was 6.7/6.3/5.5 D, but was irregular and not measurable in 74 %/52 %/49 %. The astigmatism increased with increasing decentration (24 months, p = 0.04). After 3/12/24 months, the VA in ulcers was 0.1/0.16/0.16, in scars 0.2/0.6/0.5 and in ectatic diseases 0.3/0.5/0.6. The position of graft and the visual acuity did not correlate significantly. After 24 months, larger the graft size was associated with better visual acuity. With increasing decentration the visual acuity decreased (p = 0.02) and was significantly lower (0.15) in the case of - 2.0 < distance < 2.0 mm than in the case of distance > 2.0 mm (0.4; p = 0.01).
The diagnosis resulting in eccentric penetrating keratoplasty seems to have a major impact on the long-term functional prognosis of visual acuity. In addition, visual acuity is limited by high and often irregular astigmatism. Our results indicate that an increasing decentration of the graft is not invariably associated with decreasing visual acuity, provided the graft-host junction is not located in direct proximity of the optical axis.
本研究旨在评估偏心同种异体穿透性角膜移植术在诊断以及角膜移植片的位置和大小方面的功能结果。
在这项回顾性研究中，分析了91例患者91只眼中117例圆形偏心同种异体穿透性角膜移植术的视力和散光情况。进行穿透性角膜移植术是因为角膜溃疡（104例）、6例角膜瘢痕和7例角膜扩张性疾病。使用84张术后切片对以下参数进行量化：移植片直径和透明度、角膜几何中心距中央环钻边缘的距离（距离）以及距移植片几何中心的距离（偏心度）。17例移植片被归类为偏心周边角膜移植术（平均直径5.0±1.7mm），光轴穿过宿主角膜，67例为偏心中央角膜移植术（7.0±1.3mm），光轴穿过移植片。
平均随访期为25个月。3/12/24个月后的散光分别为6.7/6.3/5.5D，但74%/52%/49%为不规则散光且无法测量。散光随偏心度增加而增加（24个月时，p = 0.04）。3/12/24个月后，角膜溃疡患者的视力分别为0.1/0.16/0.16，角膜瘢痕患者为0.2/0.6/0.5，角膜扩张性疾病患者为0.3/0.5/0.6。移植片位置与视力无显著相关性。24个月后，移植片尺寸越大，视力越好。随着偏心度增加，视力下降（p = 0.02），当-2.0 <距离< 2.0mm时视力显著低于距离> 2.0mm时（0.15对0.4；p = 0.01）。
导致偏心穿透性角膜移植术的诊断似乎对视力的长期功能预后有重大影响。此外，视力受高度且通常不规则的散光限制。我们的结果表明，只要移植片与宿主的交界处不在光轴附近，移植片偏心度增加并不总是与视力下降相关。
