Gutfreund Shay, Leon Pia, Busin Massimo
*Department of Ophthalmology, "Villa Igea" Private Hospital, Forlì, Italy; †Department of Ophthalmology, Assaf Harofeh Medical Center, Tzrifin, Israel; and ‡Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy.
Cornea. 2017 Jul;36(7):880-883. doi: 10.1097/ICO.0000000000001232.
To describe the surgical technique and report the outcomes of patients treated with microkeratome-assisted anterior lamellar keratoplasty (MALK) for the correction of high-degree postkeratoplasty astigmatism.
Four eyes of 2 patients with extremely high (>10 D) and irregular [surface asymmetry index >1.0 D] post-penetrating keratoplasty astigmatism occurring after complete suture removal underwent MALK and were followed for at least 3 years after the procedure. In all cases, 250-µm lamellar keratectomy was performed, followed by 2 full-thickness incisions through the penetrating keratoplasty scar and the placement of an appropriately sized donor graft, which was secured with a double-running 10-0 nylon suture. All sutures were removed in all eyes within 1 year from surgery. Corrected distance visual acuity, refraction, corneal topography, and endothelial cell density were noted at each examination.
At the last follow-up examination (3 years or longer after MALK), corrected distance visual acuity had improved to 20/20, refractive astigmatism had decreased to an average of 2.1 D (in all cases within 4.5 D), and the average surface asymmetry index had reduced from 2.27 to 0.56.
MALK is an effective and safe technique for the correction of high-degree postkeratoplasty astigmatism.
描述手术技术，并报告接受微型角膜刀辅助前板层角膜移植术（MALK）治疗高度角膜移植术后散光患者的治疗效果。
2例患者的4只眼在完全拆除缝线后出现极高（>10 D）且不规则[表面不对称指数>1.0 D]的穿透性角膜移植术后散光，接受了MALK治疗，并在术后至少随访3年。所有病例均进行了250μm的板层角膜切除术，随后通过穿透性角膜移植瘢痕进行2条全层切口，并植入尺寸合适的供体植片，用10-0尼龙线双行连续缝合固定。所有眼睛均在术后1年内拆除所有缝线。每次检查时记录矫正远视力、屈光、角膜地形图和内皮细胞密度。
在最后一次随访检查时（MALK术后3年或更长时间），矫正远视力提高到20/20，屈光性散光平均降至2.1 D（所有病例均在4.5 D以内），平均表面不对称指数从2.27降至0.56。
MALK是一种有效且安全的治疗高度角膜移植术后散光的技术。
