Speaker M G, Lugo M, Laibson P R, Rubinfeld R S, Stein R M, Genvert G I, Cohen E J, Arentsen J J
Cornea Service, Wills Eye Hospital, Philadelphia, PA 19107.
Ophthalmology. 1988 Sep;95(9):1260-8. doi: 10.1016/s0161-6420(88)33037-x.
Management of the intraocular lens (IOL) at the time of penetrating keratoplasty (PK) for pseudophakic bullous keratopathy has been based on lens-related factors and coexisting anterior segment abnormalities. The authors reviewed the results of PK for 102 cases of pseudophakic bullous keratopathy (43 anterior chamber, 50 iris-supported, and 9 posterior chamber) with respect to: (1) the type of IOL, (2) coexisting abnormalities, and (3) management of the IOL at surgery. Graft failure after 2 years of follow-up was: (1) retained iris-supported IOLs, 9%; (2) retained anterior chamber IOLs, 60%; (3) retained posterior chamber intraocular lenses (PC IOL), 0%; (4) removed IOLs, 9%; and (5) exchanged IOLs, 20%. After 5 years of follow-up, 13 of 13 PKs with retained closed-loop anterior chamber IOLs had failed. Visual results were best in eyes with retained iris-supported, rigid anterior chamber or PC IOLs and when the IOL was removed without replacement. The authors recommend that closed-loop anterior chamber lenses and unstable lenses of any type be removed or exchanged and that well-fixated PC IOLs and iris-clip IOLs be retained at the time of PK for pseudophakic bullous keratopathy.
在穿透性角膜移植术（PK）治疗人工晶状体眼大泡性角膜病变时，人工晶状体（IOL）的处理基于与晶状体相关的因素及并存的眼前节异常情况。作者回顾了102例人工晶状体眼大泡性角膜病变（43例前房型、50例虹膜支撑型和9例后房型）的穿透性角膜移植术结果，涉及以下方面：（1）人工晶状体类型；（2）并存的异常情况；（3）手术时人工晶状体的处理。随访2年后的植片失败率为：（1）保留虹膜支撑型人工晶状体，9%；（2）保留前房型人工晶状体，60%；（3）保留后房型人工晶状体（PC IOL），0%；（4）取出人工晶状体，9%；（5）更换人工晶状体，20%。随访5年后，13例保留闭环前房型人工晶状体的穿透性角膜移植术中有13例失败。视力结果在保留虹膜支撑型、硬性前房型或后房型人工晶状体的眼中最佳，以及在取出人工晶状体未进行置换时最佳。作者建议，在穿透性角膜移植术治疗人工晶状体眼大泡性角膜病变时，应取出或更换闭环前房型晶状体及任何类型的不稳定晶状体，保留固定良好的后房型人工晶状体和虹膜夹型人工晶状体。
