Jarade Elias, Antonios Rafic, El-Khoury Sylvain
aMediclinic Dubai Mall, Dubai, United Arab Emirates, Beirut, Lebanon.
bBeirut Eye Specialist Hospital, Beirut, Lebanon.
Case Rep Ophthalmol. 2017 Apr 28;8(1):279-287. doi: 10.1159/000471789. eCollection 2017 Jan-Apr.
To describe the technique of limbal stem cell-sparing corneoscleroplasty for the management of advanced keratoglobus.
A patient with bilateral advanced keratoglobus, with best-corrected visual acuity of 20/400 in the right eye and 20/200 in the left eye, underwent limbal stem cell-sparing corneoscleroplasty of the right eye. Initially, a 360-degree limbal incision with 200-μm depth was created, followed by a sublimbal tunnel dissection into the sclera, in order to conserve stem cells. Next, a limbus-to-limbus lamellar keratectomy at 200-μm depth was performed. Meanwhile, a donor corneoscleral button with preserved endothelium of the central 8 mm was fashioned. Prior to suturing the donor corneoscleral graft using a modified suturing technique to cover its scleral component, a full-thickness trephination of 8-mm diameter was completed in the central host cornea.
Reepithelialization occurred within the first week. No episodes of rejection, intraocular pressure spikes, or epithelial breakdown were observed postoperatively. At the 6-month follow-up, the patient had 20/70 best-corrected vision and a smooth cornea with regular astigmatism on topography.
Limbal stem cell-sparing corneoscleroplasty is a single-step technique for restoring the structural integrity of the cornea in advanced keratoglobus while preserving the host limbal stem cells.
描述保留角膜缘干细胞的角膜巩膜成形术治疗晚期球形角膜的技术。
一名双侧晚期球形角膜患者，右眼最佳矫正视力为20/400，左眼为20/200，接受了右眼保留角膜缘干细胞的角膜巩膜成形术。首先，制作一个深度为200μm的360度角膜缘切口，然后进行巩膜下隧道分离进入巩膜，以保留干细胞。接下来，进行深度为200μm的全角膜缘板层角膜切除术。同时，制作一个中央8mm内皮保留的供体角膜巩膜纽扣。在使用改良缝合技术缝合供体角膜巩膜移植物以覆盖其巩膜部分之前，在中央宿主角膜完成一个直径8mm的全层环钻术。
第一周内实现了上皮化。术后未观察到排斥反应、眼压峰值或上皮破损情况。在6个月的随访中，患者最佳矫正视力为20/70，角膜光滑，地形图显示有规则散光。
保留角膜缘干细胞的角膜巩膜成形术是一种单步技术，可在保留宿主角膜缘干细胞的同时恢复晚期球形角膜的角膜结构完整性。
