R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Australia.
Curr Opin Ophthalmol. 2010 Jul;21(4):293-300. doi: 10.1097/ICU.0b013e32833a8e23.
The purpose of this review is to provide an update of peer-reviewed literature published over the previous 2 years on various aspects of therapeutic keratoplasty.
Therapeutic keratoplasty has a definitive role in the management of progressive microbial keratitis refractory to medical therapy. The primary aim of the procedure is to eliminate the infectious disease process and establish the integrity of the globe. This procedure offers a microbiological cure rate of up to 100% in bacterial keratitis; recurrence of infection remains a concern following fungal infections and Acanthamoeba keratitis. Newer techniques like corneal debulking allow maximal preservation of the iris tissue in cases of perforated corneal ulcers. Lamellar procedures are emerging as promising alternatives to the full thickness graft in cases of infectious keratitis sparing the Descemet's membrane. In addition to adept intraoperative skills, intensive postoperative treatment and meticulous follow-up are pivotal to ensure success of a therapeutic graft.
Therapeutic keratoplasty is a challenging procedure and is associated with a poor prognosis for graft survival as compared with the optical grafts. The recent advances in lamellar keratoplasty and antimicrobial therapy contribute to the success in terms of microbiological cure and improved visual outcomes.
本文旨在对过去 2 年中有关治疗性角膜移植术各个方面的同行评议文献进行更新。
治疗性角膜移植术在治疗药物难治性进展性微生物角膜炎方面具有明确作用。该手术的主要目的是消除感染过程并保持眼球完整性。细菌性角膜炎的手术成功率高达 100%；真菌感染和棘阿米巴角膜炎复发仍是关注的问题。对于穿孔性角膜溃疡，角膜削薄等新技术可最大程度地保留虹膜组织。对于感染性角膜炎，板层手术作为全厚度移植物的替代方法正在出现，可保留角膜后弹力层。除了熟练的手术技能外，强化术后治疗和细致的随访对于确保治疗性移植物的成功至关重要。
与光学性移植相比，治疗性角膜移植术是一项具有挑战性的手术，其移植物存活率的预后较差。近年来，板层角膜移植术和抗菌治疗的进步有助于在微生物学治愈率和改善视力方面取得成功。
