Fogla Rajesh, Knyazer Boris
*Department of Ophthalmology, Apollo Hospitals, Andhra Pradesh, Hyderabad, India; and †Faculty of Health Sciences, Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Cornea. 2014 Oct;33(10):1118-22. doi: 10.1097/ICO.0000000000000189.
The aim of this study was to describe a microkeratome-assisted 2-stage technique of superficial anterior lamellar keratoplasty (SALK) to manage Reis-Bucklers corneal dystrophy (RBCD).
A microkeratome was used to create a 9-mm, 140-μm-thick corneal flap in the first stage. Four weeks later, in the second stage, a Hessberg-Baron suction trephine was used to perform a 7.0-mm central trephination up to a depth of 150 μm, within the corneal flap. Donor lamellar tissue was prepared using a microkeratome system, after which a vacuum punch was used to trephine a 7.0-mm lamellar button. This donor button was used to replace the central corneal flap in the recipient cornea without using any sutures. A bandage contact lens was applied for 2 weeks.
This modified technique of staged sutureless SALK was used in 4 eyes of 2 patients with RBCD. Postoperatively, all eyes experienced an improvement in both uncorrected and best spectacle-corrected visual acuities. The average best spectacle-corrected visual acuity was 20/30 at the last follow-up (19 months, range 16-22 months). The cornea remained clear in all eyes until the last follow-up without any evidence of recurrence of RBCD.
The staged technique of microkeratome-assisted SALK allows the replacement of superficial corneal stroma without the necessity for any sutures and seems to be a safe and effective method for the treatment of RBCD.
本研究旨在描述一种使用微型角膜刀辅助的两阶段技术进行浅层前板层角膜移植术（SALK）来治疗Reis-Bucklers角膜营养不良（RBCD）。
第一阶段使用微型角膜刀制作一个9毫米、厚度为140微米的角膜瓣。四周后，在第二阶段，使用Hessberg-Baron吸引环钻在角膜瓣内进行7.0毫米的中央环钻，深度达150微米。使用微型角膜刀系统制备供体板层组织后，用真空打孔器钻取一个7.0毫米的板层纽扣。该供体纽扣用于替换受体角膜中的中央角膜瓣，无需使用任何缝线。佩戴绷带接触镜2周。
这种改良的分期无缝合SALK技术应用于2例RBCD患者的4只眼中。术后，所有眼睛的未矫正视力和最佳矫正视力均有所改善。最后一次随访（19个月，范围16 - 22个月）时，平均最佳矫正视力为20/30。所有眼睛的角膜直至最后一次随访时均保持清晰，无RBCD复发的迹象。
微型角膜刀辅助的SALK分期技术可在无需任何缝线的情况下替换浅层角膜基质，似乎是治疗RBCD的一种安全有效的方法。
