Goins Kenneth M
Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242-1091, USA.
Int Ophthalmol. 2008 Jun;28(3):233-46. doi: 10.1007/s10792-007-9140-z.
Penetrating keratoplasty (PK) became the standard of care for optical and tectonic rehabilitation of corneal blindness and visual impairment in the second half of the twentieth century. Posterior corneal disorders or endotheliopathies are the reason for one-third to one-half of all corneal transplants today in the US. Any procedure that replaces the endothelium ideally should accomplish the following results: (1) a smooth surface topography without significant change in astigmatism, (2) a highly predictable corneal power, (3) a healthy donor endothelium that resolves all edema, (4) a tectonically stable globe, safe from injury and infection, and (5) an optically pure cornea. Although PK consistently can achieve results 3 and 5 above, the other goals of stable topography, predictable corneal power and tectonic stability, have remained elusive despite our best efforts at ingenious suturing and trephination techniques. Endothelial keratoplasty (EK) is a new surgical procedure designed to replace diseased corneal endothelium with healthy donor endothelium through either a lamellar corneal flap approach or through limbal scleral incision, leaving the surface of the recipient cornea untouched by surface corneal sutures. This manuscript evaluates the impact and future of EK in ophthalmology.
穿透性角膜移植术（PK）在20世纪下半叶成为角膜盲和视力损害的光学和结构性修复的标准治疗方法。在美国，后角膜疾病或内皮病变是当今所有角膜移植手术三分之一到二分之一的病因。理想情况下，任何替代内皮的手术都应取得以下结果：（1）表面地形光滑，散光无明显变化；（2）角膜屈光力高度可预测；（3）健康的供体内皮可消除所有水肿；（4）眼球结构稳定，免受损伤和感染；（5）角膜光学纯净。尽管PK始终能够实现上述结果3和5，但尽管我们在巧妙的缝合和环切技术方面尽了最大努力，稳定的地形、可预测的角膜屈光力和结构稳定性等其他目标仍然难以实现。内皮角膜移植术（EK）是一种新的手术方法，旨在通过角膜板层瓣入路或通过角膜缘巩膜切口，用健康的供体内皮替代患病的角膜内皮，使受体角膜表面不受角膜表面缝线的影响。本文评估了EK在眼科领域的影响和未来发展。
