Saragoussi J J, Abenhaim A, Waked N, Koster H R, Pouliquen Y J
Department of Ophthalmology, Hotel-Dieu Hospital, Paris, France.
Refract Corneal Surg. 1992 Jan-Feb;8(1):33-8.
High astigmatism is still a common complication of penetrating keratoplasty which often limits the final corrected visual acuity. Surgical correction of high astigmatism persistent after suture removal remains rather controversial. In our present study, we used the technique of transverse keratotomies for the surgical correction of high astigmatism following penetrating keratoplasty because of its simplicity and corrective potential.
We present a retrospective clinical study based on the results of 48 consecutive transverse keratotomy procedures performed on the graft. Three eyes were operated on twice, for a total of 51 procedures. The astigmatism had to be stable for at least 6 months after suture removal, with poor corrected visual acuity with spectacles or contact lenses. The operative protocol (number of incisions, optical zone size) was decided based on the degree of astigmatism. The mean post-operative observation period was 5.11 +/- 3.93 months (range, 1 to 24 months).
The mean preoperative cylinder was 8.96 +/- 2.22 diopters and 4.91 +/- 1.79 D postoperatively. The mean cylindrical change was 4.51 +/- 2.77 D. The spherical equivalent remained unchanged in most cases. In a majority of cases, the corrected visual acuity for distance and near vision was improved. No cases of persistent graft edema caused by immunologic rejection or endothelial failure were observed. Moreover, in no case was there worsening of the best corrected visual acuity.
The technique of transverse incisions in the graft to correct or reduce high postkeratoplasty astigmatism is simple, efficient, and relatively safe. The main problem was poor predictability.
高度散光仍是穿透性角膜移植术常见的并发症，常限制最终矫正视力。缝线拆除后对持续存在的高度散光进行手术矫正仍颇具争议。在本研究中，我们采用横向角膜切开术来手术矫正穿透性角膜移植术后的高度散光，因其操作简单且具有矫正潜力。
我们基于对连续48例在移植片上进行横向角膜切开术的结果开展了一项回顾性临床研究。3只眼接受了两次手术，共进行了51次手术。散光在缝线拆除后必须稳定至少6个月，且佩戴眼镜或隐形眼镜时矫正视力不佳。手术方案（切口数量、光学区大小）根据散光程度确定。术后平均观察期为5.11±3.93个月（范围1至24个月）。
术前平均柱镜度数为8.96±2.22屈光度，术后为4.91±1.79屈光度。平均柱镜度数变化为4.51±2.77屈光度。大多数情况下球镜等效度保持不变。在大多数病例中，远视力和近视力的矫正视力均得到改善。未观察到因免疫排斥或内皮功能衰竭导致的持续性移植片水肿病例。此外，最佳矫正视力无恶化情况。
在移植片上进行横向切口以矫正或减少角膜移植术后高度散光的技术操作简单、有效且相对安全。主要问题是可预测性较差。
