Eye Department, Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, Lanarkshire, UK.
Cornea. 2011 Feb;30(2):180-3. doi: 10.1097/ICO.0b013e3181ca2b8c.
The purpose of this case series was to evaluate the effectiveness of modified deep anterior lamellar keratoplasty in eyes with scarring secondary to hydrops associated with keratoconus.
Four patients underwent modified deep anterior lamellar keratoplasty. This was performed by controlled air injection and layer-by-layer dissection of the corneal stroma. The corneal stroma was dissected up to 95% thickness using a Beaver blade. The host Descemet membrane (DM) (4 mm in diameter) that was incorporated in the scar was excised. The DM and the endothelium from the donor button were removed, and the graft was applied to the recipient bed. Twenty percentage sulfur hexafluoride gas was injected to tamponade the host DM to the donor cornea. The graft was sutured with 10-0 monofilament nylon. An amniotic membrane dressing was applied.
The preoperative visual acuity was between counting fingers to 6/36. Six weeks postoperatively, the grafts were clear. At 1-year follow-up, the best-corrected visual acuity was 6/12 or better in all patients.
Modification of deep anterior lamellar keratoplasty may be an effective alternative to penetrating keratoplasty in eyes with corneal scarring because of previous hydrops.
本病例系列研究旨在评估改良深层前板层角膜移植术治疗与圆锥角膜相关的水肿继发瘢痕的疗效。
4 例患者接受了改良深层前板层角膜移植术。该手术采用可控空气注射和角膜基质的逐层分离进行。使用 Beaver 刀片将角膜基质分离至 95%的厚度。包含在瘢痕中的供体角膜后弹力膜（DM）（直径 4 毫米）被切除。从供体纽扣中去除 DM 和内皮细胞，并将移植物应用于受者床。20%六氟化硫气体注入以填塞宿主 DM 至供体角膜。移植物用 10-0 单丝尼龙缝线缝合。应用羊膜敷料。
术前视力在指数至 6/36 之间。术后 6 周，移植物透明。在 1 年的随访中，所有患者的最佳矫正视力均为 6/12 或更好。
对于因先前水肿导致角膜瘢痕的眼睛，改良深层前板层角膜移植术可能是穿透性角膜移植术的有效替代方法。
