Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751.
Clin Exp Ophthalmol. 2010 Mar;38(2):118-27. doi: 10.1111/j.1442-9071.2009.02180.x. Epub 2009 Nov 30.
Newer forms of lamellar keratoplasty techniques have emerged in the last decade or so revolving around the concept of targeted replacement of diseased corneal layers. These include anterior lamellar keratoplasty (ALK) techniques that aim to selectively replace diseased corneal stroma and, endothelial keratoplasty techniques aiming to replaced damaged endothelium in endothelial disorders. ALK surgery has a distinct advantage over penetrating keratoplasty (PK) in that it minimizes unnecessary replacement of the unaffected healthy endothelial layer thereby almost eliminating the risk of endothelial rejection, a major cause of graft failure in PK. Overall it provides increased life expectancy to the graft and with advancements in the surgical technique and instrumentation for ALK, the visual outcomes are now comparable if not better to standard PK. There are several forms of ALK procedures that have evolved to cater to a wide range of stromal disorders. This article reviews the various emerging techniques of anterior lamellar surgery, its indications and visual outcomes, to emphasize the shift from PK to ALK for stromal disorders with a healthy endothelium.
在过去的十年左右，出现了一些新型的板层角膜移植技术，这些技术围绕着有针对性地替换病变角膜层的概念展开。其中包括旨在选择性替换病变角膜基质的前板层角膜移植（ALK）技术，以及旨在替换内皮疾病中受损内皮的内皮角膜移植技术。与穿透性角膜移植术（PK）相比，ALK 手术具有明显的优势，因为它最大限度地减少了对未受影响的健康内皮层的不必要替换，从而几乎消除了内皮排斥的风险，内皮排斥是 PK 中移植物失败的主要原因。总体而言，它增加了移植物的预期寿命，并且随着 ALK 手术技术和仪器的进步，其视觉效果现在与标准 PK 相比甚至更好。已经出现了几种 ALK 手术形式，可以满足广泛的基质疾病的需求。本文综述了各种新兴的前板层手术技术及其适应证和视觉效果，强调了从 PK 向具有健康内皮的基质疾病转向 ALK 的趋势。
