MacEwen C J, Khan Z U, Anderson E, MacEwen C G
Glasgow Eye Infirmary, Scotland.
Ophthalmic Surg. 1988 Oct;19(10):706-12.
The results of 62 repeat penetrating keratoplasties (41 eyes) over a 10-year period are presented. The common indications for the primary graft include herpes simplex keratitis, pseudophakic bullous keratopathy, aphakic bullous keratopathy, Fuch's endothelial dystrophy, and chronic ulceration. All cases of pseudophakic bullous keratopathy had the iris-clip type of intraocular lens. Graft failure was attributed to rejection, endothelial failure, recurrent ulceration, herpes simplex keratitis, melting, trauma, and recurrent dystrophy. At the end of the study period 28 grafts (68%) were clear and 13 (32%) were opaque. Visual improvement occurred in 28 eyes (68%), deterioration in four (10%), and six (15%) remained unchanged (visual result was not available in three eyes). These data are encouraging in terms of visual outcome and graft clarity in cases of repeat penetrating keratoplasty. Comparison is made between the primary indications and outcome of these re-grafts and eyes requiring only one graft. Initial indications for grafting in both groups were similar, other than keratoconus, which was a significantly more common indication in eyes that required only one graft. Final visual results were better in those eyes undergoing only one graft, compared with those that required multiple surgery.
本文呈现了10年间62例（41只眼）穿透性角膜移植术重复手术的结果。初次移植的常见适应证包括单纯疱疹性角膜炎、人工晶状体眼大泡性角膜病变、无晶状体眼大泡性角膜病变、富克斯内皮营养不良和慢性溃疡。所有人工晶状体眼大泡性角膜病变病例均为虹膜夹型人工晶状体。移植失败的原因包括排斥反应、内皮功能衰竭、复发性溃疡、单纯疱疹性角膜炎、角膜溶解、外伤和复发性营养不良。在研究期末，28只移植眼（68%）透明，13只（32%）混浊。28只眼（68%）视力改善，4只（10%）视力恶化，6只（15%）视力无变化（3只眼无视力结果）。这些数据在重复穿透性角膜移植术的视力结果和移植透明度方面令人鼓舞。对这些再次移植眼和仅需一次移植眼的初次适应证及结果进行了比较。两组移植的初始适应证相似，但圆锥角膜除外，圆锥角膜在仅需一次移植的眼中是明显更常见的适应证。与需要多次手术的眼相比，仅接受一次移植的眼最终视力结果更好。
