Singapore National Eye Centre, Singapore.
Lancet. 2012 May 5;379(9827):1749-61. doi: 10.1016/S0140-6736(12)60437-1.
Corneal transplantation or keratoplasty has developed rapidly in the past 10 years. Penetrating keratoplasty, a procedure consisting of full-thickness replacement of the cornea, has been the dominant procedure for more than half a century, and successfully caters to most causes of corneal blindness. The adoption by specialist surgeons of newer forms of lamellar transplantation surgery, which selectively replace only diseased layers of the cornea, has been a fundamental change in recent years. Deep anterior lamellar keratoplasty is replacing penetrating keratoplasty for disorders affecting the corneal stromal layers, while eliminating the risk of endothelial rejection. Endothelial keratoplasty, which selectively replaces the corneal endothelium in patients with endothelial disease, has resulted in more rapid and predictable visual outcomes. Other emerging therapies are ocular surface reconstruction and artificial cornea (keratoprosthesis) surgery, which have become more widely available because of rapid advances in these techniques. Collectively, these advances have resulted in improved outcomes, and have expanded the number of cases of corneal blindness, which can now be treated successfully. Femtosecond-laser-assisted surgery, bioengineered corneas, and medical treatment for endothelial disease are also likely to play a part in the future.
在过去的 10 年中，角膜移植术或角膜移植术发展迅速。穿透性角膜移植术是一种全层角膜置换术，半个多世纪以来一直占据主导地位，成功地满足了大多数角膜盲的原因。近年来，专科医生采用了选择性地仅置换病变角膜层的新型板层移植手术，这是一个根本性的变化。深层前板层角膜移植术正在取代穿透性角膜移植术，用于治疗影响角膜基质层的疾病，同时消除内皮排斥的风险。内皮角膜移植术选择性地置换内皮疾病患者的角膜内皮，可获得更快、更可预测的视力结果。其他新兴疗法包括眼表重建和人工角膜（角膜假体）手术，由于这些技术的快速进步，这些疗法已经变得更加普及。总之，这些进步提高了治疗效果，并扩大了可以成功治疗的角膜盲病例数量。飞秒激光辅助手术、生物工程角膜和内皮疾病的药物治疗也可能在未来发挥作用。
