Rajendra Prasad Centre for Ophthalmic Sciences, Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India.
Eye Contact Lens. 2012 Mar;38(2):112-5. doi: 10.1097/ICL.0b013e318243e82c.
The aim was to evaluate the efficacy of autokeratoplasty as an alternative to conventional allograft transplantation for the management of corneal blindness in patients with a healthy cornea in the fellow blind eye.
A retrospective analysis of all consecutive cases of corneal blindness that were treated with autokeratoplasty was undertaken. We describe nine cases in which the healthy, transparent cornea from a blind eye was transplanted onto the fellow eye with a favorable visual potential but an opaque cornea. The parameters evaluated were uncorrected visual acuity, best-corrected visual acuity (BCVA), endothelial cell loss, graft clarity, and complications if any.
The median age of the patients was 63 years (range 37-83 years). Intraoperative complications encountered included expulsive hemorrhage (n=1), retrieval of a corneal button unsuitable for transplantation onto the donor defect (n=1), and problems concerning sizing of the corneal graft (n=1). Glycerine-preserved cornea was used in two eyes. All the patients achieved BCVA >20/60 by 3 months postoperatively, and 8 of the 9 patients (88.9%) maintained a clear graft till the last follow-up (12 months-78 months). Endothelial cell loss of 31.4%± 6.3%, 33.2%±5.9%, 34.7%±8.2% was noted at 1, 6, and 12 months, respectively. Accelerated endothelial cell loss after three episodes of traumatic wound dehiscence was responsible for nonimmunological graft failure in one case.
Autokeratoplasty is a viable option in selected cases of corneal blindness as an alternative to conventional allograft transplantation. In the event of adverse events, a backup tissue should be available.
评估同种异体角膜移植术治疗健康对侧盲眼角膜混浊患者的疗效。
对所有连续接受同种异体角膜移植术治疗的角膜盲患者进行回顾性分析。我们描述了 9 例病例，即将健康、透明的盲眼角膜移植到有良好视力潜力但角膜混浊的对侧眼。评估的参数包括未矫正视力、最佳矫正视力（BCVA）、内皮细胞丢失、移植物清晰度以及任何并发症。
患者的中位年龄为 63 岁（范围 37-83 岁）。术中并发症包括：驱逐性出血（n=1）、获取不适合移植到供体缺陷的角膜瓣（n=1）以及角膜移植片尺寸问题（n=1）。使用甘油保存角膜的有 2 只眼。所有患者术后 3 个月均获得 BCVA>20/60，9 例患者中的 8 例（88.9%）在最后一次随访（12 个月-78 个月）时保持透明移植物。术后 1、6 和 12 个月时内皮细胞丢失分别为 31.4%±6.3%、33.2%±5.9%和 34.7%±8.2%。1 例患者因 3 次创伤性伤口裂开导致非免疫性移植物失功，出现内皮细胞加速丢失。
同种异体角膜移植术是治疗健康对侧盲眼角膜混浊患者的一种可行选择，可替代传统同种异体移植术。在发生不良事件时，应准备好备用组织。
