Hassan Shadab, Noorani Sorath, Zaheer Naima, Jabeen Sidra
Department of Pediatric Ophthalmology and Strabismus, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan.
J Pak Med Assoc. 2023 Jan;73(1):54-59. doi: 10.47391/JPMA.5532.
To evaluate the anatomical outcome of tectonic grafts performed in children with perforated or melted corneas.
The prospective study was conducted at the Department of Paediatric Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, from January to December 2017, and comprised children of either gender aged <16 years who received tectonic grafts owing to desmetocoele or corneal perforation of >3mm. The causes of corneal perforation, size of perforation, post-operative graft outcome and globe integrity were noted. Periodic follow-ups were done till December 2019. Data was analysed using SPSS 22.
Of the 27 patients, 9(33.3%) were girls and 18(66.7%) were boys. The overall mean age was 47.7±43.5 months. The most common indication was corneal perforation 19(70.4%), followed by descemetocoele 8(29.6%). The most frequent cause was infectious keratitis 13(48.2%), followed by trauma 8(29.6%) and vitamin A deficiency 5(18.5%). The mean size of perforation/descemetocoele was 5.5±1.5mm. Post-operatively, graft failure occurred in 5(18.5%) eyes and required repeat grafts. Globe integrity was restored in all 27(100%) cases, and 24(88.8%) eyes maintained their size and intraocular pressure, while 3(11.1%) became phthisical. Post-operative visual acuity was better than 6/36 in 3(11.1%) eyes, between 6/36 and 6/60 in 10(37%) and counting finger in 14(51.8%).
Tectonic graft was found to be a valuable therapeutic option in emergency globe-threatening corneal thinning and perforation and in maintaining the anatomical integrity of eyes.
评估为角膜穿孔或融解患儿实施的结构性移植的解剖学结果。
本前瞻性研究于2017年1月至12月在巴基斯坦拉瓦尔品第阿法信托眼科医院小儿眼科进行，纳入年龄<16岁因角膜后弹力层膨出或角膜穿孔>3mm而接受结构性移植的患儿。记录角膜穿孔的原因、穿孔大小、术后移植结果及眼球完整性。定期随访至2019年12月。使用SPSS 22对数据进行分析。
27例患者中，女孩9例（33.3%），男孩18例（66.7%）。总体平均年龄为47.7±43.5个月。最常见的指征是角膜穿孔19例（70.4%），其次是角膜后弹力层膨出8例（29.6%）。最常见的病因是感染性角膜炎13例（48.2%），其次是外伤8例（29.6%）和维生素A缺乏5例（18.5%）。穿孔/角膜后弹力层膨出的平均大小为5.5±1.5mm。术后，5只眼（18.5%）发生移植失败，需要再次移植。所有27例（100%）病例的眼球完整性得以恢复，24只眼（88.8%）维持其大小和眼压，而3只眼（11.1%）萎缩。术后视力优于6/36的有3只眼（11.1%），介于6/36和6/60之间的有10只眼（37%），能数指的有14只眼（51.8%）。
在紧急威胁眼球的角膜变薄和穿孔以及维持眼球解剖完整性方面，结构性移植是一种有价值的治疗选择。
