Klinik für Augenheilkunde, St.-Johannes-Hospital, Dortmund, Deutschland.
Klin Monbl Augenheilkd. 2022 Aug;239(8):1025-1032. doi: 10.1055/a-1328-2685. Epub 2021 Mar 17.
Tectonic eccentric sclerokeratoplasty à chaud is a very complex corneal operation and aims to preserve the eyeball and possibly to improve visual acuity in patients with peripheral corneal ulcerations or perforating corneal trauma.
1650 eyes received corneal transplants in our clinic between 2006 and 2019. 14 of these 1650 eyes (0.8%) had a perforated or predescemetal peripheral corneal ulceration and these were treated between 2006 and 2019 with a tectonic eccentric sclerokeratoplasty à chaud. The mean age of the 8 women and 6 men included in this case series was 63 years (22 - 91 years).
In the postoperative follow-up period, most complications and reoperations occurred in the first 6 months. Re-ulceration was observed in 2 cases as well as early suture loosening in 12 patients. These 2 cases were treated with a partial conjunctival flap. Additionally, prolonged superficial wound healing process was shown in 12 patients. Therefore 27 amniotic membrane transplantations, 12 suture replacements, and 6 partial conjunctival flaps were performed in total. No re-keratoplasties were required in this case series. All eyes could be stabilised through the sclerokeratoplasty as well as subsequent operations and intensive local or even systemic treatment. After removal of the corneal suture, the best-corrected visual acuity improved only insignificantly to hand movement in 1 case, finger counting in 3 cases, 0.1 in 5 cases, 0.2 in 4 cases and 0.5 in 1 case. Preservation of the eyeball with pain relief was achieved in all 14 eyes.
Eccentric sclerokeratoplasty is a very demanding surgical procedure and is extremely rarely performed. The goal is to preserve the eye.
热式构造性偏心板层角膜移植术是一种非常复杂的角膜手术，旨在保留眼球，并可能提高周边角膜溃疡或穿透性角膜外伤患者的视力。
2006 年至 2019 年期间，我们诊所共为 1650 只眼睛进行了角膜移植。其中 14 只（0.8%）患有穿孔或前房角膜溃疡，在 2006 年至 2019 年期间采用热式构造性偏心板层角膜移植术进行治疗。本病例系列纳入的 8 名女性和 6 名男性的平均年龄为 63 岁（22-91 岁）。
在术后随访期间，大多数并发症和再次手术发生在最初的 6 个月内。2 例出现再溃疡，12 例出现早期缝线松动。这 2 例患者接受了部分结膜瓣治疗。此外，12 例患者表现出迁延性浅层伤口愈合过程。因此，共进行了 27 次羊膜移植、12 次缝线更换和 6 次部分结膜瓣手术。本病例系列中无需再次进行角膜移植。通过板层角膜移植术以及随后的手术和强化局部甚至全身治疗，所有眼睛均得以稳定。在去除角膜缝线后，1 例视力仅略有改善至手动，3 例视力为指数计数，5 例视力为 0.1，4 例视力为 0.2，1 例视力为 0.5。所有 14 只眼睛均保留了眼球并缓解了疼痛。
偏心板层角膜移植术是一种要求极高的手术，极少见施行。其目的是保留眼球。
