Parker Cornea, Birmingham, Alabama, USA.
Netherlands Institute for Innovative Ocular Surgery- USA (NIIOS-USA), San Diego, California, USA.
Ophthalmic Res. 2021;64(4):532-553. doi: 10.1159/000516093. Epub 2021 Mar 24.
For nearly a century, the definitive treatment of many corneal dystrophies and ectactic disorders was limited to penetrating keratoplasty, but over the past 2 decades, a surge of surgical innovation has propelled the treatment of many corneal diseases to more targeted approaches with significantly better visual outcomes. Anterior stromal diseases were first changed through endothelial-sparing techniques, such as deep anterior lamellar keratoplasty, but have more recently transitioned to stromal-sparing approaches. Ultraviolet corneal crosslinking strengthens the cornea and halts progression of keratoconus in >90% of cases. Intracorneal ring segment and corneal allogenic ring segment implantation offer methods to flatten ectatic corneas. However, Bowman layer transplantation - inlay and more recently onlay techniques - has shown promise for treating advanced keratoconus and preventing keratoplasty. The advent of endothelial keratoplasty radically changed the treatment of corneal endothelial dysfunction, and Descemet membrane endothelial keratoplasty specifically offers an average postoperative visual acuity of 20/25 (0.8) with only 8.8% of grafts requiring retransplantation in the first 5 years. Here, we review the rapid innovations for surgical treatment of corneal diseases, spanning from endothelial keratoplasty and endothelial regeneration to anterior lamellar keratoplasty and stromal augmentation, highlighting key steps which may be moving us closer to a "postkeratoplasty" world.
近一个世纪以来，许多角膜营养不良和扩张性疾病的标准治疗方法仅限于穿透性角膜移植术，但在过去的 20 年中，大量的手术创新推动了许多角膜疾病的治疗向更具针对性的方法发展，从而获得了更好的视觉效果。首先通过内皮细胞保存技术（如深板层角膜移植术）改变了前部基质疾病，但最近已过渡到基质保存方法。紫外线角膜交联术可增强角膜强度并阻止 90%以上圆锥角膜的进展。角膜内环段和同种异体角膜环段植入术为平坦扩张性角膜提供了方法。但是，Bowman 层移植术（嵌体和最近的覆盖技术）已显示出治疗晚期圆锥角膜和预防角膜移植的潜力。内皮角膜移植术的出现彻底改变了角膜内皮功能障碍的治疗方法，而 Descemet 膜内皮角膜移植术特别提供了 20/25（0.8）的平均术后视力，在前 5 年中只有 8.8%的移植物需要再次移植。在这里，我们回顾了角膜疾病手术治疗的快速创新，涵盖了从内皮角膜移植术和内皮再生到前板层角膜移植术和基质增强，强调了可能使我们更接近“后角膜移植术”世界的关键步骤。
