Chua Awy, Chua M J, Kam Pca
Anaesth Intensive Care. 2018 Mar;46(2):162-170. doi: 10.1177/0310057X1804600204.
Significant surgical advances have been made recently in corneal transplantation. Penetrating keratoplasty was the dominant method from 1905, until selective lamellar keratoplasty emerged as the preferred technique over the last 20 years. Advanced techniques such as corneal limbal stem cell transplant and keratoprosthesis are also available. The major surgical complications of corneal transplantation are extrusion of ocular content and expulsive choroidal haemorrhage. It is essential for an ophthalmic anaesthetist to have a good understanding of these new surgical procedures so as to provide optimal surgical conditions. This article aims to inform anaesthetists about the recent surgical advances in corneal transplantation and explore the anaesthetic considerations of these new techniques. General anaesthesia remains suitable for a wide range of these procedures especially in repeat surgery, difficult, or prolonged procedures. Regional ophthalmic blocks are ideal for endothelial keratoplasty but can be used in penetrating keratoplasty based on individual risk-benefit assessment, and as a supplement to general anaesthesia. Topical anaesthesia provides an alternative when general anaesthesia and ophthalmic regional blocks are less desirable but overall its use is limited.
近年来角膜移植手术取得了重大进展。从1905年起，穿透性角膜移植术一直是主要方法，直到在过去20年中选择性板层角膜移植术成为首选技术。角膜缘干细胞移植和角膜假体等先进技术也已出现。角膜移植的主要手术并发症是眼内容物挤出和脉络膜爆发性出血。眼科麻醉医生必须充分了解这些新的手术操作，以便提供最佳手术条件。本文旨在向麻醉医生介绍角膜移植手术的最新进展，并探讨这些新技术的麻醉注意事项。全身麻醉仍然适用于多种此类手术，尤其是再次手术、困难或长时间的手术。局部眼科阻滞对于内皮角膜移植术是理想的，但基于个体风险效益评估，也可用于穿透性角膜移植术，并作为全身麻醉的补充。当全身麻醉和眼科局部阻滞不太适宜时，表面麻醉提供了一种替代方法，但总体而言其应用有限。
