John Thomas, Tighe Sean, Sheha Hosam
Thomas John Vision Institute, Tinley Park, IL, USA.
Department of Ophthalmology, Loyola University at Chicago, Maywood, IL, USA.
Clin Ophthalmol. 2021 Oct 2;15:3993-3996. doi: 10.2147/OPTH.S326306. eCollection 2021.
Corneal melt remains a challenging complication of Boston keratoprosthesis (KPro) and may lead to disastrous consequences such as endophthalmitis, KPro extrusion, and permanent loss of vision. Several procedures have been suggested to repair established melts; however, KPro removal or exchange is often required due to high recurrence. We herein describe a novel surgical technique to repair corneal melt: a lamellar corneal graft is centrally trephined, and a radial cut is extended from the central opening to create a keyhole graft. The graft is draped around the KPro and tightly secured around the central stem. The radial cut is closed with sutures, and the graft is secured into the underlying tissue with fibrin glue and sutures. The graft remains stable with the KPro in place, while the patients maintain a 20/200 vision or better at two years. This technique is a useful alternative for securing KPro and preventing corneal melt recurrence.
角膜融解仍然是波士顿人工角膜（KPro）的一个具有挑战性的并发症，可能导致诸如眼内炎、KPro 脱出和永久性视力丧失等灾难性后果。已经提出了几种修复已形成的融解的手术方法；然而，由于高复发率，通常需要移除或更换 KPro。我们在此描述一种修复角膜融解的新型手术技术：在角膜板层移植物中央进行环钻，从中央开口延伸出一条放射状切口以形成钥匙孔状移植物。将移植物覆盖在 KPro 周围，并围绕中央柄紧密固定。用缝线闭合放射状切口，并用纤维蛋白胶和缝线将移植物固定到下方组织中。在 KPro 在位的情况下，移植物保持稳定，同时患者在两年时保持 20/200 或更好的视力。该技术是固定 KPro 和防止角膜融解复发的一种有用的替代方法。
