Cheung Albert Y, Sarnicola Enrica, Kurji Khaliq H, Genereux Brad M, Holland Edward J
Cincinnati Eye Institute, Cincinnati, OH.
Department of Ophthalmology, University of Cincinnati, Cincinnati, OH.
Cornea. 2018 Feb;37(2):260-262. doi: 10.1097/ICO.0000000000001433.
To report a case of extensive Fuchs superficial marginal keratitis managed with annular lamellar keratoplasty.
Interventional case report.
A 72-year-old man presented with 20/80 best-corrected visual acuity in his left eye and demonstrated 360-degree peripheral deep immune stromal keratitis and pseudopterygia with peripheral stromal thinning. During superficial keratectomy with amniotic membrane transplantation, the thin cornea was perforated while excising pseudopterygia in the superonasal quadrant. Surgery was aborted. Anterior segment optical coherence tomography demonstrated a severely thinned cornea (240 μm nasally, 360 μm temporally) with overlying pseudopterygia peripherally. After allowing 3 months for the cornea to heal, the decision was made to perform lamellar annular (or "donut") keratoplasty. The patient had an unremarkable postoperative course, with 20/50 best-corrected visual acuity 10 months after keratoplasty.
We report an extensive case of Fuchs superficial marginal keratitis treated with 360-degree annular lamellar keratoplasty. This technique provides tectonic support to decrease the likelihood of future perforation while also improving vision by modifying the ectatic cornea. Anterior segment optical coherence tomography may be a helpful tool preoperatively to avoid severely thinned areas (eg, during pseduopterygium removal) and to ensure complete removal of the ectatic cornea.
报告一例采用环形板层角膜移植术治疗的广泛型富克斯浅层边缘性角膜炎病例。
介入性病例报告。
一名72岁男性，左眼最佳矫正视力为20/80，表现为360度周边深层免疫性基质角膜炎及伴有周边基质变薄的假性翼状胬肉。在羊膜移植的浅层角膜切除术过程中，在切除鼻上象限的假性翼状胬肉时，薄角膜被穿孔。手术中止。眼前节光学相干断层扫描显示角膜严重变薄（鼻侧240μm，颞侧360μm），周边有假性翼状胬肉覆盖。在让角膜愈合3个月后，决定进行板层环形（或“甜甜圈”）角膜移植术。患者术后病程平稳，角膜移植术后10个月最佳矫正视力为20/50。
我们报告了一例采用360度环形板层角膜移植术治疗的广泛型富克斯浅层边缘性角膜炎病例。该技术提供了结构性支撑，以降低未来穿孔的可能性，同时通过改变扩张的角膜来改善视力。眼前节光学相干断层扫描术前可能是一种有用的工具，可避免严重变薄区域（如在切除假性翼状胬肉期间），并确保完全切除扩张的角膜。
