Hartmann Lennart M, Buchwald Hans-Juergen, Elhardt Carolin, Vounotrypidis Efstathios, Wolf Armin, Wertheimer Christian M
Department of Ophthalmology, Ulm University, Prittwitzstraße 43, 89075 Ulm, Germany.
Vision (Basel). 2023 Sep 21;7(3):62. doi: 10.3390/vision7030062.
Severe corneal ulcerations, causing major keratolysis with large perforation of the cornea or extending to the limbal region, are an ophthalmic emergency. In these cases, a larger corneoscleral graft can be transplanted to restore tectonic integrity, alleviate pain, save vision, and prevent loss of the eye. Chart review of 34 patients with a corneoscleral graft ≥9.5 mm was conducted. Primary endpoints of the study were tectonic stability defined as no need for another keratoplasty or enucleation. In addition, visual acuity, postoperative complications, and secondary procedures were analyzed. In total, 12 patients (35%) were female. The mean age at transplantation was 65 ± 19 years. The underlying disease was a perforated infectious corneal ulcer in 30 cases (88%). Mean follow up was 675 ± 789 days. Tectonic stability at the end of the follow-up was maintained with a probability of 56% in a Kaplan-Meier analysis. Another penetrating keratoplasty was necessary in six cases (17%) and enucleation in five cases (15%). A corneoscleral transplant remains a viable treatment option to prevent enucleation in severe keratolysis. In our study, this was possible in about half of the cases. Postoperative complications, secondary surgeries, and markedly reduced visual acuity put the advantages into perspective.
严重的角膜溃疡，导致严重的角膜溶解并伴有角膜大穿孔或延伸至角膜缘区域，是一种眼科急症。在这些病例中，可以移植更大的角巩膜移植物以恢复结构完整性、减轻疼痛、挽救视力并防止眼球丧失。对34例接受≥9.5毫米角巩膜移植物的患者进行了病历回顾。该研究的主要终点是结构稳定性，定义为无需再次进行角膜移植术或眼球摘除术。此外，还分析了视力、术后并发症和二次手术情况。共有12例患者（35%）为女性。移植时的平均年龄为65±19岁。30例（88%）的潜在疾病为穿孔性感染性角膜溃疡。平均随访时间为675±789天。在Kaplan-Meier分析中，随访结束时结构稳定性的维持概率为56%。6例（17%）需要再次进行穿透性角膜移植术，5例（15%）需要进行眼球摘除术。角巩膜移植仍然是预防严重角膜溶解时眼球摘除的一种可行治疗选择。在我们的研究中，大约一半的病例可以实现这一点。术后并发症、二次手术以及明显降低的视力使这种优势具有相对性。
