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[小儿角膜手术与角膜移植]

[Pediatric corneal surgery and corneal transplantation].

作者信息

Bachmann B, Avgitidou G, Siebelmann S, Cursiefen C

机构信息

Zentrum für Augenheilkunde, Universität zu Köln, Kerpenerstr. 62, 50937, Köln, Deutschland,

出版信息

Ophthalmologe. 2015 Feb;112(2):110-7. doi: 10.1007/s00347-014-3053-9.

Abstract

The surgical treatment of congenital corneal diseases or corneal diseases occurring during infancy is demanding even for experienced corneal surgeons. Besides the need for frequent examinations under anesthesia during the postoperative follow-up in young children and infants (e.g. after corneal transplantation), the surgeon frequently encounters intraoperative and postoperative problems, such as low scleral rigidity, positive vitreous pressure and a narrow anterior chamber. Other problems include increased fibrin reaction, an increased risk of rejection in cases of allogenic corneal transplantation and frequent loosening of sutures necessitating replacement or early removal. Lamellar corneal transplantation reduces the risk of graft rejection and the risk of wound leakage. Moreover, posterior lamellar keratoplasty in children offers a faster visual recovery compared to penetrating keratoplasty and thus reduces the risk of amblyopia.

摘要

即使对于经验丰富的角膜外科医生而言,先天性角膜疾病或婴儿期出现的角膜疾病的外科治疗也颇具挑战性。除了在幼儿和婴儿术后随访期间(如角膜移植术后)需要频繁在麻醉下进行检查外,外科医生还经常遇到术中及术后问题,如巩膜硬度低、玻璃体压力阳性和前房狭窄。其他问题包括纤维蛋白反应增加、同种异体角膜移植时排斥风险增加以及缝线频繁松动,需要更换或提前拆除。板层角膜移植降低了移植排斥风险和伤口渗漏风险。此外,与穿透性角膜移植相比,儿童后板层角膜移植能使视力恢复更快,从而降低了弱视风险。

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