Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Surv Ophthalmol. 2021 Mar-Apr;66(2):290-307. doi: 10.1016/j.survophthal.2020.08.004. Epub 2020 Aug 29.
Penetrating keratoplasty is often required in microbial keratitis not responding to the standard treatments available or the development of complications like corneal perforation. Performing keratoplasty in microbial keratitis has several challenges, the major ones being the availability of donor corneal tissue and the poor success of the corneal graft performed in such a setting. For overcoming these challenges, several alternatives to keratoplasty have been described. Broadly, these options could be categorized into autologous tissues such as conjunctival and tenon tissue, synthetic products like tissue adhesives and therapeutic contact lenses, or biological tissues like amniotic membrane graft. These alternative modalities are not universal. They have their specific indications in microbial keratitis. Most of these alternatives are useful only for small corneal perforations. While autologous tissues are cost-effective and readily available, lack of tectonic support is a significant limitation. Tissue adhesives are excellent alternatives in terms of tectonic support, but surface irregularity and tissue reaction are their potential limitations. The amniotic membrane is useful for small corneal perforations, but availability, cost, and poor tectonic support restrict its use. Herein, we discuss these various alternatives to keratoplasty in microbial keratitis, their indications, advantages, disadvantages, and the various techniques of performing these procedures.
穿透性角膜移植术通常在微生物角膜炎对现有标准治疗无反应或出现角膜穿孔等并发症时需要进行。在微生物角膜炎中进行角膜移植术有几个挑战，主要问题是供体角膜组织的可用性和在这种情况下进行的角膜移植的成功率低。为了克服这些挑战，已经描述了几种替代角膜移植的方法。广义而言，这些选择可以分为自体组织，如结膜和腱组织，合成产品，如组织粘合剂和治疗性隐形眼镜，或生物组织，如羊膜移植。这些替代方式并非通用。它们在微生物角膜炎中有其特定的适应证。这些替代方法中的大多数仅适用于小的角膜穿孔。虽然自体组织具有成本效益且易于获得，但缺乏组织支持是一个重大限制。组织粘合剂在组织支持方面是极好的替代品，但表面不规则和组织反应是其潜在的局限性。羊膜对于小的角膜穿孔很有用，但可用性、成本和较差的组织支持限制了其使用。在此，我们讨论了微生物角膜炎中各种替代角膜移植的方法、它们的适应证、优点、缺点以及进行这些手术的各种技术。
