Tugal-Tutkun I, Akova Y A, Foster C S
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114, USA.
Ophthalmology. 1995 Apr;102(4):576-85. doi: 10.1016/s0161-6420(95)30980-3.
The outcome of successful penetrating keratoplasty (PK) typically is poor in eyes with end-stage chronic cicatrizing conjunctival diseases such as ocular cicatricial pemphigoid (OCP), Stevens-Johnson syndrome, and toxic epidermal necrolysis due to immunologically driven conjunctival inflammation associated with conjunctival cicatrization and lid abnormalities, severe dry eye, and extensive corneal neovascularization. The authors report the results of their experience with PK in 13 patients with OCP, Stevens-Johnson syndrome, and toxic epidermal necrolysis.
The authors reviewed the records of patients with OCP, Stevens-Johnson syndrome, or toxic epidermal necrolysis seen between 1976 and 1992. Patients who underwent PK were examined for the purpose of this study. Initial and final visual acuity, indications for PK, surgical procedure, postoperative therapy, complications, total number of repeat PKs, length of follow-up, and the final outcome were recorded.
Thirty-two PKs were performed in 16 eyes of 13 patients with advanced OCP (6 patients), OCP as a sequela of Stevens-Johnson syndrome (2 patients), Stevens-Johnson syndrome (3 patients), and toxic epidermal necrolysis (2 patients). The indications for the first PK were corneal perforation in six eyes (37.5%) and extensive corneal scarring in ten eyes (62.5%). Preoperative visual acuity was counting fingers in five eyes, hand motions in eight, and light perception in three. Preoperative therapy included systemic chemotherapy (8 patients), mucous membrane grafting (9 eyes), lamellar keratoplasty (2 eyes), superficial keratectomy (1 eye), and corneal dye laser photocoagulation (6 eyes). The mean follow-up period was 4.6 years (3 months-13 years). Eight eyes (50%) had clear grafts, and three eyes (18.7%) had 20/200 or better visual acuity at last visit. The major causes of graft failure were epithelial defect formation/persistence, stromal ulceration, perforation, and graft rejection.
These results indicate that PK may be performed for tectonic reasons, but prospects for restoration of sight in patients with advanced cicatrizing conjunctival diseases, even after extensive preoperative medical and surgical therapy, are limited.
对于患有终末期慢性瘢痕性结膜疾病（如瘢痕性类天疱疮、史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症）的眼睛，成功的穿透性角膜移植术（PK）的结果通常较差，这是由于免疫驱动的结膜炎症与结膜瘢痕化、眼睑异常、严重干眼和广泛的角膜新生血管形成有关。作者报告了他们对13例瘢痕性类天疱疮、史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症患者进行PK的经验结果。
作者回顾了1976年至1992年间诊治的瘢痕性类天疱疮、史蒂文斯-约翰逊综合征或中毒性表皮坏死松解症患者的记录。为了本研究的目的，对接受PK的患者进行了检查。记录初始和最终视力、PK的适应证、手术过程、术后治疗、并发症、重复PK的总数、随访时间和最终结果。
对13例患者（晚期瘢痕性类天疱疮6例、史蒂文斯-约翰逊综合征后遗症所致瘢痕性类天疱疮2例、史蒂文斯-约翰逊综合征3例、中毒性表皮坏死松解症2例）的16只眼睛进行了32次PK。首次PK的适应证为6只眼睛（37.5%）角膜穿孔和10只眼睛（62.5%）广泛角膜瘢痕形成。术前视力为5只眼睛数指，8只眼睛手动，3只眼睛光感。术前治疗包括全身化疗（8例）、黏膜移植（9只眼睛）、板层角膜移植术（2只眼睛）、浅层角膜切除术（1只眼睛）和角膜染料激光光凝术（6只眼睛）。平均随访期为4.6年（3个月至13年）。最后一次随访时，8只眼睛（50%）移植片透明，3只眼睛（18.7%）视力达到20/200或更好。移植失败的主要原因是上皮缺损形成/持续、基质溃疡、穿孔和移植排斥反应。
这些结果表明，PK可因结构性原因而进行，但即使经过广泛的术前药物和手术治疗，晚期瘢痕性结膜疾病患者恢复视力的前景仍然有限。
