Bineshfar Niloufar, Tahvildari Azin, Feizi Sepehr
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136, USA.
Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ther Adv Ophthalmol. 2023 Oct 16;15:25158414231204717. doi: 10.1177/25158414231204717. eCollection 2023 Jan-Dec.
Even after a successful corneal transplant, patients experience severe refractive errors, impeding their rehabilitation and satisfaction. Refractive errors can be caused by recipient pathology and corneal thickness, as well as intraoperative factors such as donor-host discrepancy, recipient's eccentric trephination, vitreous length, wound apposition, technique of suturing, and suture material. Also, wound healing and the interim between keratoplasty and suture removal contribute to astigmatism. Lamellar keratoplasty outperforms penetrating keratoplasty in terms of endothelial cell loss and endothelial graft rejection, yet the risk of developing refractive errors is comparable. Nonsurgical interventions such as spectacles and lenses fail to provide desirable vision in cases with high astigmatism and corneal irregularity. When these limitations are encountered, surgical interventions including incisional keratotomy, wedge resection, laser refractive surgeries, intracorneal segments, and intraocular lens implantation are employed. However, occasionally, none of these approaches deliver the desired effects, leading to the need for a repeat keratoplasty.
即使角膜移植手术成功，患者仍会出现严重的屈光不正，这阻碍了他们的康复并影响满意度。屈光不正可能由受体病理和角膜厚度引起，也受术中因素影响，如供体与受体差异、受体偏心环切、玻璃体长度、伤口对合、缝合技术和缝合材料。此外，伤口愈合以及角膜移植术与拆线之间的间隔也会导致散光。在角膜内皮细胞损失和内皮移植排斥方面，板层角膜移植术优于穿透性角膜移植术，但发生屈光不正的风险相当。眼镜和镜片等非手术干预措施在高散光和角膜不规则的情况下无法提供理想视力。当遇到这些限制时，会采用包括切口角膜切开术、楔形切除术、激光屈光手术、角膜内植入物和人工晶状体植入在内的手术干预措施。然而，有时这些方法都无法达到预期效果，导致需要再次进行角膜移植术。
