Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany.
Cornea. 2023 Mar 1;42(3):272-279. doi: 10.1097/ICO.0000000000003035. Epub 2022 May 12.
The purpose of this study was to analyze the indications and clinical results of emergency penetrating keratoplasty with simultaneous cataract surgery ("Triple-PKP à chaud").
This study included all subjects who underwent Triple-PKP à chaud between 2006 and 2020 at the Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar in Germany. Data obtained from patient records were retrospectively analyzed.
Triple-PKP à chaud was successfully performed in 27 of 29 eyes with a mean age of 66.0 ± 19.9 years. Previous surgery was performed in 20 eyes (69.0%), most frequently amniotic membrane transplantation in 11 eyes (37.9%) and previous keratoplasty in 9 eyes (31.0%). The most common indication was infectious keratitis (62.1%). In 27 subjects (93.1%), capsulorhexis was performed using the open-sky technique. The most frequent intraoperative complication was positive vitreous pressure (24.1%). In 2 eyes (6.9%), no intraocular lens implantation was performed because of posterior capsule rupture. The preoperative uncorrected visual acuity improved from 2.2 ± 0.6 logMAR (range = 3.0-0.7 logMAR) to 1.3 ± 0.7 logMAR (range = 3.0-0.18 logMAR) postoperatively ( P < 0.001). Common postoperative complications were suture loosening (44.4%) and corneal epithelial defects (33.3%). Repeat keratoplasty was necessary in 14 eyes (51.9%), including 9 eyes (64.2%) within 12 months postoperatively. The mean graft survival was 12.2 ± 17.9 months (range = 1-69 mo).
Triple-PKP is also feasible in emergency conditions. Nevertheless, the surgery is associated with an increased risk of intraoperative and postoperative complications. Combined surgery should, therefore, only be performed in severely diseased eyes with progressed stage of cataract.
本研究旨在分析急诊穿透性角膜移植术联合白内障手术（“热 Triple-PKP”）的适应证和临床结果。
本研究纳入了 2006 年至 2020 年期间在德国萨尔兰大学医学中心洪堡/萨尔眼科部门接受 Triple-PKP à chaud 的所有患者。回顾性分析患者病历中获得的数据。
29 只眼中有 27 只眼成功进行了 Triple-PKP à chaud，平均年龄为 66.0 ± 19.9 岁。20 只眼（69.0%）之前曾接受过手术，最常见的是 11 只眼（37.9%）行羊膜移植术和 9 只眼（31.0%）行穿透性角膜移植术。最常见的适应证是感染性角膜炎（62.1%）。在 27 名患者（93.1%）中，采用开天空技术行晶状体囊切开术。最常见的术中并发症是玻璃体压阳性（24.1%）。由于后囊破裂，2 只眼（6.9%）未行人工晶状体植入。术前未矫正视力从 2.2 ± 0.6 logMAR（范围 = 3.0-0.7 logMAR）提高到术后 1.3 ± 0.7 logMAR（范围 = 3.0-0.18 logMAR）（P < 0.001）。常见的术后并发症包括缝线松动（44.4%）和角膜上皮缺损（33.3%）。14 只眼（51.9%）需要再次行角膜移植术，其中 9 只眼（64.2%）在术后 12 个月内需要再次手术。平均移植物存活率为 12.2 ± 17.9 个月（范围 = 1-69 个月）。
在紧急情况下也可以进行 Triple-PKP，但该手术与术中及术后并发症的风险增加相关。因此，联合手术仅应在白内障进展期且疾病严重的患眼进行。
