Sugar A, Meyer R F, Heidemann D, Kaplan S, Berka T, Maguire K, Martonyi C
Ophthalmology. 1985 Mar;92(3):325-30. doi: 10.1016/s0161-6420(85)34033-2.
Pseudophakic bullous keratopathy (PBK) has become the leading indication for penetrating keratoplasty. In our initial fifty patients having keratoplasty for PBK there was gradual loss of clear grafts in patients with retained intraocular lenses (IOLs). Specular microscopy was performed on donor tissue, and periodically postoperatively, for 130 grafts for PBK. The highest cell loss at one year was in eyes with retained iris support (39.2%) or anterior chamber (37.2%) IOLs. Cell loss in grafts with removed iris support IOLs (21.3%) was significantly less. When iris support IOLs were exchanged for anterior chamber (AC) IOLs, the cell loss at one year (27.1%) was intermediate. We recommend that iris support IOLs be removed at keratoplasty. Exchange for an AC IOL should be considered depending on the visual needs of each patient. Removal of AC IOLs should be based on consideration of prior tolerance and position of the implant.
人工晶状体性大泡性角膜病变（PBK）已成为穿透性角膜移植术的主要适应证。在我们最初接受PBK角膜移植术的50例患者中，保留人工晶状体（IOL）的患者移植片透明度逐渐丧失。对用于PBK的130片移植片的供体组织进行了镜面显微镜检查，并在术后定期进行检查。一年时细胞丢失率最高的是保留虹膜支撑（39.2%）或前房型（37.2%）人工晶状体的眼睛。移除虹膜支撑人工晶状体的移植片细胞丢失率（21.3%）明显较低。当将虹膜支撑人工晶状体换成前房型（AC）人工晶状体时，一年时的细胞丢失率（27.1%）处于中间水平。我们建议在角膜移植术时移除虹膜支撑人工晶状体。应根据每位患者的视觉需求考虑换成AC人工晶状体。是否移除AC人工晶状体应基于对植入物先前耐受性和位置的考虑。
