Tan Donald T H, Por Yong-Ming
Singapore National Eye Centre, Singapore Eye Research Institute, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Curr Opin Ophthalmol. 2007 Jul;18(4):284-9. doi: 10.1097/ICU.0b013e3281a7ecaa.
The approach to the management of various forms of corneal ectasia is changing, with the advent of new surgical and nonsurgical options. The purpose of this review is to summarize and evaluate relevant studies on new treatments for keratoconus, postrefractive surgery keratectasia, and peripheral ectatic corneal disorders.
Various alternatives to corneal transplantation for the management of keratoconus aim to enhance corneal rigidity by means of nonsurgical collagen cross-linking, or with the use of intrastromal corneal ring segments, and studies suggest that these treatments may reduce astigmatism or ectatic progression to varying degrees. Recent developments in anterior lamellar keratoplasty enable targeted replacement or augmentation of corneal stroma without replacement of endothelium, and include procedures such as deep anterior lamellar keratoplasty, microkeratome or laser-assisted anterior lamellar surgery, and peripheral tectonic lamellar keratoplasty procedures demonstrate successful reinforcement of peripheral stroma to reduce astigmatism.
These new forms of surgery are viable alternatives to conventional penetrating keratoplasty and bring added safety profiles for long-term visual rehabilitation and restoration of tectonic integrity in central and peripheral forms of corneal ectasia.
随着新的手术和非手术治疗方法的出现，各种形式角膜扩张症的治疗方法正在发生变化。本综述的目的是总结和评估有关圆锥角膜、屈光手术后角膜扩张症以及周边角膜扩张性疾病新治疗方法的相关研究。
用于治疗圆锥角膜的角膜移植的各种替代方法旨在通过非手术性胶原交联或使用基质内角膜环片来增强角膜硬度，并且研究表明这些治疗方法可能在不同程度上减少散光或扩张进展。前板层角膜移植术的最新进展能够在不置换内皮的情况下有针对性地置换或增厚角膜基质，包括诸如深板层角膜移植术、微型角膜刀或激光辅助前板层手术等手术，并且周边结构性板层角膜移植手术证明能够成功加固周边基质以减少散光。
这些新的手术形式是传统穿透性角膜移植术的可行替代方法，为中央和周边形式的角膜扩张症的长期视力康复和结构完整性恢复带来了更高的安全性。
