Price Francis W, Price Marianne O
Price Vision Group, 9002 North Meridian Street, Suite 100, Indianapolis, IN 46260, USA.
Int Ophthalmol. 2008 Jun;28(3):141-6. doi: 10.1007/s10792-007-9183-1.
Adult keratoplasty outcomes have significantly improved in the past quarter century as a result of new pharmaceuticals, advanced surgical devices, better understanding of what causes graft failure, and targeted techniques for selective replacement of only diseased corneal layers. Prevention and treatment of graft rejection, which has long been a leading cause of graft failure, has improved with the development of innovative topical and systemic immuno-suppressants. New methods for preventing and treating ocular surface complications have been devised, and limbal stem cell grafts have significantly improved management of severe ocular surface disease. Improved intraocular lens designs cause less corneal damage and have increased corneal graft survival. Non-steroidal anti-inflammatory (NSAID) eyedrops and more complete vitrectomies have reduced the incidence of chronic cystoid macular edema, which could prevent eyes with clear grafts from regaining useful vision. Patients with keratoconus or corneal scars can now benefit from advanced anterior lamellar keratoplasty techniques, which reduce the risk of immunologic rejection and endothelial failure, while matching the visual outcomes achieved with penetrating keratoplasty. Patients with endothelial dysfunction can now benefit from advanced endothelial keratoplasty techniques, which provide more rapid visual recovery, minimize induced astigmatism and ocular surface problems, and virtually eliminate the risk of wound rupture from minor trauma. Finally, femtosecond lasers now provide transplant surgeons with a precise tool for creating complex, interlocking corneal incisions that may facilitate wound healing.
在过去的四分之一世纪里，成人角膜移植的效果有了显著改善，这得益于新型药物、先进的手术设备、对移植失败原因的更深入了解，以及仅选择性替换病变角膜层的靶向技术。长期以来，移植排斥一直是移植失败的主要原因，随着新型局部和全身免疫抑制剂的研发，其预防和治疗水平得到了提高。已经设计出了预防和治疗眼表并发症的新方法，角膜缘干细胞移植显著改善了严重眼表疾病的治疗效果。改进后的人工晶状体设计对角膜的损伤更小，提高了角膜移植的存活率。非甾体抗炎眼药水和更完善的玻璃体切除术降低了慢性黄斑囊样水肿的发生率，而这种水肿可能会使移植透明的眼睛无法恢复有用视力。圆锥角膜或角膜瘢痕患者现在可以受益于先进的前板层角膜移植技术，该技术降低了免疫排斥和内皮功能衰竭的风险，同时能达到穿透性角膜移植的视觉效果。内皮功能障碍患者现在可以受益于先进的内皮角膜移植技术，该技术能使视力恢复更快，将诱导性散光和眼表问题降至最低，并几乎消除了轻微创伤导致伤口破裂的风险。最后，飞秒激光现在为移植外科医生提供了一种精确工具，用于制作复杂的、相互连锁的角膜切口，这可能有助于伤口愈合。
