Cornea, Cataract and Refractive Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.
Cornea, Cataract and Refractive Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.
Surv Ophthalmol. 2020 Nov-Dec;65(6):675-690. doi: 10.1016/j.survophthal.2020.04.002. Epub 2020 Apr 17.
Lamellar keratoplasty procedures have gained momentum in the field of corneal transplantation because of their inherent advantages over full-thickness penetrating keratoplasty. While penetrating keratoplasty is an open sky procedure fraught with sight-threatening intraoperative and postoperative complications, lamellar keratoplasties are relatively closed-system procedures that involve selective removal and replacement of diseased corneal layers and are free from these complications. Anterior lamellar procedures involve partial or lamellar replacement of anterior stroma and reduce the risk of graft rejection, retain structural integrity, and require less stringent donor criteria. Posterior lamellar procedures involve removal of the affected endothelium in eyes with relatively unaffected stroma. These procedures are associated with improved safety profile, accelerated wound healing, structurally stronger globe, and minimal astigmatism, thereby producing faster visual rehabilitation and timely initiation of amblyopia therapy in children. Although the use of lamellar grafts is increasing in adults, their relatively slower adoption in pediatric population is attributable to the steep learning curve and lack of long-term follow-up data. We describe the challenges associated with these procedures and their outcomes in pediatric eyes.
板层角膜移植术在角膜移植领域得到了迅猛发展，因为它相对于全层穿透性角膜移植术具有内在优势。穿透性角膜移植术是一种开放性手术，术中及术后存在威胁视力的并发症，而板层角膜移植术则是一种相对封闭系统的手术，涉及选择性去除和替换病变的角膜层，且不会发生这些并发症。前板层手术涉及前基质的部分或板层替换，降低了移植物排斥的风险，保留了结构完整性，并且对供体的要求不那么严格。后板层手术则涉及到在相对不受影响的基质的眼中去除受影响的内皮。这些手术与更好的安全性、更快的伤口愈合、结构更强的眼球以及最小的散光有关，从而使儿童更快地恢复视力，并及时开始弱视治疗。虽然板层移植物在成人中的应用越来越多，但在儿科人群中的应用相对较慢，这是由于陡峭的学习曲线和缺乏长期随访数据。我们描述了这些手术在儿科眼睛中面临的挑战及其结果。
