Thatte Shreya, Dube Ankita B, Dubey Trupti, Krishnan Malvika
Department of Ophthalmology, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India.
J Curr Ophthalmol. 2020 Mar 23;32(1):38-45. doi: 10.4103/JOCO.JOCO_24_20. eCollection 2020 Jan-Mar.
To assess the achievement of anatomical integrity after primary tectonic sclerokeratoplasty procedure and outcome after subsequent secondary procedures to manage devastating corneoscleral infection threatening the structural integrity of the eyeball.
This prospective interventional study comprised 60 patients with severe devastating corneoscleral pathology of infective origin with varying degrees of scleral involvement who underwent tectonic sclerokeratoplasty. They were grouped into three groups according to the involvement of scleral quadrants, i.e., Group A with only one quadrant, Group B with two quadrants, and Group C with more than two quadrants. The demographics, clinical features, microbiological status, postoperative complications, need for secondary procedures, and tectonic outcome in terms of anatomical success were analyzed in all three groups during follow-up between 2 and 5 years.
The donor graft size in Groups A, B, and C was 9.5-10.5, 11-12, and 12.5-14 mm, respectively. Globe integrity after primary procedure was noted in all patients of Group A, 76% of Group B, and 38% of Group C. Reinfection was observed in 19 cases of Groups B and C, from which 5 Group C patients were eviscerated and 14 underwent regrafting. Postoperative complications (suture related, rejection, graft failure, and secondary glaucoma) were encountered more frequently in Group C patients. Secondary procedures (cataract/posterior segment surgery, secondary intraocular lens, and trabeculectomy) were required more in Groups B and C. After regrafting, 7 eyes were salvaged and 7 (3 in Group B and 4 in Group C) resulted in phthisis bulbi. Thus, tectonic outcome was achieved in 80% of cases.
Sclerokeratoplasty is an effective tectonic treatment for restoring the globe anatomy in severe corneoscleral infection. Outcome depends on involvement of scleral quadrants, graft size, and severity of disease. Subsequent regrafting procedures are required to overcome reinfection of the primary graft.
评估初次结构性巩膜角膜移植术后的解剖完整性实现情况，以及后续二级手术治疗威胁眼球结构完整性的严重角膜巩膜感染的效果。
这项前瞻性干预性研究纳入了60例因感染导致严重角膜巩膜病变且巩膜受累程度不同的患者，他们接受了结构性巩膜角膜移植术。根据巩膜象限受累情况将他们分为三组，即A组仅一个象限受累，B组两个象限受累，C组两个以上象限受累。在2至5年的随访期间，对所有三组患者的人口统计学、临床特征、微生物学状况、术后并发症、二级手术需求以及解剖学成功方面的结构性结果进行了分析。
A组、B组和C组的供体移植物大小分别为9.5 - 10.5、11 - 12和12.5 - 14毫米。A组所有患者、B组76%的患者和C组38%的患者在初次手术后眼球保持完整。B组和C组有19例出现再次感染，其中C组5例患者眼球摘除，14例接受再次移植。C组患者术后并发症（缝线相关、排斥反应、移植物失败和继发性青光眼）更为常见。B组和C组需要更多的二级手术（白内障/后段手术、二期人工晶状体植入和小梁切除术）。再次移植后，挽救了7只眼，7只眼（B组3只，C组4只）导致眼球痨。因此，80%的病例实现了结构性结果。
巩膜角膜移植术是恢复严重角膜巩膜感染眼球解剖结构的有效结构性治疗方法。结果取决于巩膜象限受累情况、移植物大小和疾病严重程度。需要后续的再次移植手术来克服初次移植物的再次感染。
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