Lockington David, Ramaesh Kanna
Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, United Kingdom.
Cornea. 2015 Feb;34(2):239-42. doi: 10.1097/ICO.0000000000000315.
We describe a novel surgical technique that seeks to address the fundamental mechanical problem of the superiorly and vertically displaced limbus and the corresponding abnormal corneal white-to-white diameter in keratoglobus.
A 42-year-old woman had progressive reduction of vision due to hydrops of her right cornea with secondary peripheral corneal perforation due to progressive bilateral keratoglobus. Her visual acuity was hand movements in the right eye, with an uncorrectable refractive error. Pachymetry ranged from 287 μm in the peripheries to 474 μm centrally. The simulated keratometry average was 87 diopters. The surgical technique includes corneal debridement, paracentesis to facilitate manipulation of the cornea, cardinal compression sutures, central anterior lamellar dissection, and mattress sutures to tuck the excess peripheral cornea to create a pleat. This intralamellar tuck formed the subsequent bed to host an anterior lamellar corneal graft.
At 1-year review, the best-corrected visual acuity was 6/24 (-2.50/+2.00 ×75 in the right eye). Central corneal pachymetry was 744 μM in the right eye. The simulated keratometry average was 42.4 diopters. This visual improvement and refraction remained stable for 3 years postoperatively.
We have demonstrated a modified anterior lamellar keratoplasty with pleat technique to achieve satisfactory visual rehabilitation in extreme keratoglobus. This pleat technique addresses the fundamental structural problem of a vertically displaced limbus in keratoglobus. We highlight the optical illusion of the white-to-white diameter in keratoglobus. We also recommend the baking analogy of muffin to cupcake as a communication aid when explaining the mechanics of surgery to the patient.
我们描述了一种新颖的手术技术，旨在解决球形角膜中上方和垂直移位的角膜缘的基本力学问题以及相应的异常角膜白到白直径。
一名42岁女性因双侧进行性球形角膜导致右眼角膜水肿并继发周边角膜穿孔，视力逐渐下降。她右眼的视力为手动，存在无法矫正的屈光不正。角膜厚度测量范围从周边的287μm到中央的474μm。模拟角膜曲率平均值为87屈光度。手术技术包括角膜清创、前房穿刺以利于角膜操作、主要压迫缝线、中央前板层剥离以及褥式缝线以将多余的周边角膜折叠形成褶。这种板层内折叠形成了后续用于植入前板层角膜移植片的床。
在1年的复查中，最佳矫正视力为6/24（右眼-2.50/+2.00×75）。右眼中央角膜厚度为744μm。模拟角膜曲率平均值为42.4屈光度。术后3年视力改善和屈光度保持稳定。
我们展示了一种改良的带褶前板层角膜移植术，在极端球形角膜病例中实现了令人满意的视力康复。这种带褶技术解决了球形角膜中垂直移位角膜缘的基本结构问题。我们强调了球形角膜中白到白直径的光学错觉。我们还推荐用松饼到纸杯蛋糕的烘焙类比作为向患者解释手术力学原理时的沟通辅助工具。
