Kruse F E, Cursiefen C
Department of Ophthalmology, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany.
Dev Ophthalmol. 2008;41:159-170. doi: 10.1159/000131087.
To demonstrate surgical treatment options for complications of severe forms of dry eye at the cornea, limbus and conjunctiva.
Corneal, limbal and conjunctival surgical treatment strategies are outlined.
Amniotic membrane transplantation, different forms of corneal transplantation and limbal stem cell surgery all are treatment options for complications of dry eye disease.
Nowadays a broad spectrum of surgical treatment options exists to treat corneal complications of severe forms of dry eye at the ocular surface. Currently available conservative therapy for patients with 'dry eye' is primarily focused on augmenting or stabilizing the tear film and reducing primary or secondary causative factors such as inflammation of the ocular surface. While most patients with 'mild' and 'moderate' forms of dry eye (accounting for more than 95% of all patients with dry eye) can be treated sufficiently with drug treatment as well as environmental measures, some patients with very severe forms of dry eye need surgical intervention. Corneal surgery in the context of dry eye has primarily the objective to correct surface pathologies of the cornea caused by severe dysfunctions of the precorneal tear film. This primarily means persistent epithelial defects of the ocular surface, corneal ulcerations and consecutive corneal scarring. Besides conservative approaches, the first can be treated by amniotic membrane transplantation. Lamellar or perforating corneal transplantations are used to treat stromal scarring or perforated ulcerations as a sequel of persistent epithelial defects and associated apoptotic degeneration of stromal keratocytes. Finally, limbal stem cell transplantation can correct limbal stem cell deficiency states associated with or caused by diseases leading to severe forms of dry eye (e.g. chemical burns leading to destruction of conjunctival mucus-producing cells). All three surgical approaches will be discussed below.
阐述针对角膜、角膜缘和结膜严重干眼症并发症的手术治疗方案。
概述角膜、角膜缘和结膜的手术治疗策略。
羊膜移植、不同形式的角膜移植和角膜缘干细胞手术均为干眼症并发症的治疗选择。
如今存在多种手术治疗方案来治疗眼表严重干眼症的角膜并发症。目前针对“干眼症”患者的保守治疗主要集中在增强或稳定泪膜以及减少诸如眼表炎症等主要或次要致病因素。虽然大多数“轻度”和“中度”干眼症患者（占所有干眼症患者的95%以上）可以通过药物治疗以及环境措施得到充分治疗，但一些非常严重的干眼症患者需要手术干预。干眼症背景下的角膜手术主要目的是纠正由角膜前泪膜严重功能障碍引起的角膜表面病变。这主要意味着眼表持续性上皮缺损、角膜溃疡以及继发性角膜瘢痕形成。除了保守方法外，第一种情况可通过羊膜移植治疗。板层或穿透性角膜移植用于治疗持续性上皮缺损及相关基质角膜细胞凋亡性变性导致的基质瘢痕或穿孔性溃疡。最后，角膜缘干细胞移植可纠正与导致严重干眼症的疾病相关或由其引起的角膜缘干细胞缺乏状态（例如化学烧伤导致结膜黏液分泌细胞破坏）。以下将对这三种手术方法进行讨论。
