Abel R, Binder P S
Ann Ophthalmol. 1975 Dec;7(12):1631-3.
The decision to extract the lens at the time of penetrating keratoplasty often depends upon the surgeon's philosophy regarding the efficacy of one-stage versus two-stage procedures, because the status of the lens in a patient with visually disabling corneal disease frequently cannot be determined before the operation. The commonly employed techniques for evaluating the clarity of the lens intraoperatively are prone to inaccuracies and often depend upon pupil size. Because a combined procedure may entail a more complicated postoperative course, some surgeons elect not to extract the lens at the time of keratoplasty. This will necessitate a second procedure which might ultimately compromise a successful corneal graft, as well as allow the possibility that some cataractous lenses may become progressively intumescent during the postoperative period and endanger the clarity of the transplant. It is, therefore, important to have a method to more accurately evaluate the status of the lens in patients with opaque corneas. The application of the coaxially-illuminated operating microscope to visualize fundus details after the corneal button has been removed permits a better estimation of the lens clarity.
在穿透性角膜移植术时决定是否摘除晶状体，通常取决于外科医生对于一期手术与二期手术疗效的看法，因为在患有导致视力障碍的角膜疾病的患者中，术前往往无法确定晶状体的状况。术中评估晶状体透明度的常用技术容易出现不准确的情况，且常常取决于瞳孔大小。由于联合手术可能会带来更复杂的术后病程，一些外科医生选择在角膜移植术时不摘除晶状体。这将需要进行第二次手术，而这可能最终会影响角膜移植的成功，并且还存在一些白内障晶状体在术后可能会逐渐肿胀并危及移植片透明度的可能性。因此，重要的是要有一种方法来更准确地评估角膜混浊患者的晶状体状况。在切除角膜植片后，应用同轴照明手术显微镜来观察眼底细节，可以更好地评估晶状体的透明度。
