Parmar Gautam Singh, Jain Divya, Borde Prashant, Meena Ashok
Department of Cornea and Refractive Surgery, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India.
Eur J Ophthalmol. 2023 May;33(3):NP27-NP30. doi: 10.1177/11206721221080812. Epub 2022 Feb 14.
To describe a new technique for management of recalcitrant deep stromal keratitis using posterior lamellar keratectomy.
A 66-year-old pseudophakic male presented with deep stromal corneal infiltrates, extending from 2 to 4 o'clock in the vicinity of the limbus of the left eye, 3 months after phacoemulsification. The infiltrates failed to respond to empirical topical medications, anterior chamber wash and intrastromal injection. Posterior lamellar keratectomy was done to debulk the infectious load. In this technique the diseased posterior lamella was excised through a sclerocorneal lamellar pocket without a donor graft.
The infection subsided within 2 weeks after posterior lamellar keratectomy. Patient achieved best corrected visual acuity (BCVA) of 20/60 with complete resolution of symptoms at 2 weeks follow up. Till the last follow-up at 6 months, the patient maintained BCVA of 20/60 with no sign of recurrence or corneal decompensation at the keratectomy site.
Posterior lamellar keratectomy is a simple, effective and inexpensive technique for management of small, peripheral, deep-seated recalcitrant keratitis. It leads to radical treatment of the disease like therapeutic penetrating keratoplasty but in a less invasive manner and without a donor graft.
描述一种使用后板层角膜切除术治疗顽固性深层基质角膜炎的新技术。
一名66岁的人工晶状体植入男性患者，在白内障超声乳化术后3个月，左眼角膜缘附近2至4点处出现深层基质角膜浸润。浸润对经验性局部用药、前房冲洗和基质内注射均无反应。进行后板层角膜切除术以减少感染负荷。在该技术中，通过巩膜角膜板层袋切除病变的后板层，无需植入供体移植物。
后板层角膜切除术后2周内感染消退。患者在2周随访时最佳矫正视力（BCVA）达到20/60，症状完全缓解。直到6个月的最后一次随访，患者维持BCVA为20/60，角膜切除部位无复发或角膜失代偿迹象。
后板层角膜切除术是一种简单、有效且廉价的技术，用于治疗小型、周边、深层顽固性角膜炎。它能像治疗性穿透性角膜移植术一样对疾病进行根治，但侵入性较小且无需供体移植物。
