Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.
Cornea Unit, Guy's & St Thomas' Hospital, London, UK.
Surv Ophthalmol. 2021 Jan-Feb;66(1):20-40. doi: 10.1016/j.survophthal.2020.10.003. Epub 2020 Oct 14.
Corneal transplantation is the most commonly performed human tissue transplantation procedure worldwide. Because of the large number of transplants, corneal graft failure has become one of the most common indications for corneal transplantation. The relatively recently developed lamellar transplant techniques have brought about specific potential complications leading to graft failure that may require different approaches to repeat transplantation other than penetrating keratoplasty. On the other hand, these new lamellar techniques also provide novel ways of rescuing failed penetrating grafts, with potential advantages over successive penetrating keratoplasties, such as reduced intraoperative risks and faster visual rehabilitation. We summarize the incidence and risk factors of graft failure for penetrating and lamellar (stromal and endothelial) corneal transplants and discuss the various surgical alternatives currently available to rescue such failed grafts, with a focus on the reported outcomes and limitations.
角膜移植是全球最常见的人类组织移植手术。由于移植数量众多，角膜移植物失功已成为角膜移植最常见的适应证之一。相对较新的板层移植技术带来了一些特定的潜在并发症，导致移植物失功，这可能需要不同于穿透性角膜移植术的再次移植方法。另一方面，这些新的板层技术也为挽救失败的穿透性移植物提供了新的途径，与连续的穿透性角膜移植术相比具有潜在优势，例如术中风险降低和更快的视力康复。我们总结了穿透性和板层（基质和内皮）角膜移植的移植物失功发生率和危险因素，并讨论了目前可用于挽救这些失败移植物的各种手术替代方法，重点介绍了报告的结果和局限性。
