Hashemi Hasan, Noori Jila, Zare Mohammad A, Rahimi Firoozeh
Farabi Eye Hospital, Ophthalmology Department, Tehran Medical Science University, Tehran, Iran.
J Refract Surg. 2007 Mar;23(3):272-8. doi: 10.3928/1081-597X-20070301-10.
To evaluate the outcome of microkeratome-assisted posterior lamellar keratoplasty for replacing diseased endothelium in pseudophakic and aphakic corneal edema.
Microkeratome-assisted posterior lamellar keratoplasty was performed on 10 eyes with pseudophakic or aphakic corneal edema. A nasal hinged 130- to 250-microm-thick flap was created with an automated microkeratome. The underlying 7.0-mm trephined button of deep stroma and endothelium was substituted with the same size donor button prepared by removing a same-sized flap and trephination of the remaining donor bed. The donor lenticule was fixated without sutures in position; the retracted flap was repositioned and sutured to the peripheral recipient tissue. The viscoelastic content of the anterior chamber was replaced by air to hold the graft in position.
All surgeries were uneventful except for one case of donor button posterior dislocation forming a secondary anterior chamber, which was corrected through donor button exchange 1 month postoperatively. All uncomplicated cases had stable refraction and corneal topography as early as 1 month after surgery, which was maintained in follow-up examinations. In two eyes, corneal astigmatism > 5.00 diopters was recorded. One case of prolonged re-epithelialization and two cases of epithelial interface ingrowth occurred.
Microkeratome-assisted posterior lamellar keratoplasty is an alternative to conventional penetrating keratoplasty for patients with diseased corneal endothelium, significantly reducing the time of visual rehabilitation. Determination of the relative advantages of this technique over penetrating keratoplasty and other recent alternative endothelial graft procedures relies on controlled prospective studies.
评估微型角膜刀辅助后板层角膜移植术治疗假晶状体眼和无晶状体眼角膜水肿时置换病变内皮的效果。
对10只患有假晶状体眼或无晶状体眼角膜水肿的眼睛进行微型角膜刀辅助后板层角膜移植术。使用自动微型角膜刀制作一个带鼻侧铰链的130至250微米厚的角膜瓣。用相同大小的供体角膜瓣和剩余供体床的环钻术制备的相同大小的供体纽扣，替换下方7.0毫米环钻的深层基质和内皮纽扣。供体晶状体悬韧带原位固定，无需缝合；将回缩的角膜瓣重新定位并缝合到周边受体组织上。前房内的粘弹性物质用空气替代，以固定移植片。
除1例供体纽扣后脱位形成继发前房外，所有手术均顺利，该病例在术后1个月通过更换供体纽扣得以纠正。所有未出现并发症的病例在术后1个月时屈光和角膜地形图就已稳定，并在随访检查中得以维持。有2只眼记录到角膜散光>5.00屈光度。发生了1例上皮化延迟和2例上皮界面内生。
对于角膜内皮病变患者，微型角膜刀辅助后板层角膜移植术是传统穿透性角膜移植术的一种替代方法，可显著缩短视力恢复时间。确定该技术相对于穿透性角膜移植术和其他近期替代内皮移植手术的相对优势，依赖于对照前瞻性研究。
