Patten J T, Cavanagh H D, Pavan-Langston D
Ann Ophthalmol. 1976 Mar;8(3):287-94.
Central corneal perforations have traditionally been managed by conjunctival flaps, tissue adhesives, soft contact lenses, corneal patches and other conservative measures for the immediate preservation of the eye. An alternative method of treatment is immediate penetrating keratoplasty. We present the result of immediate keratoplasty for 25 eyes referred with acute central corneal perforations, 20 of herpetic origin and 5 with a chemical burn or dry eye syndrome. In all cases, the eye was successfully preserved. Twelve of 20 grafts (60%) for herpetic perforation went on to eventual clear grafts as opposed to 1 of 5 grafts (20%) in the dry eye or chemically burned patients. Significant complications encountered included cataract formation, secondary glaucoma and persistent epithelial defects; however, these should not preclude eventual restoration of good visual acuity. Penetrating keratoplasty in acutely inflamed and perforated eyes used to lead to angle closure and secondary glaucoma in a considerable number of cases, sometimes progressing to total disaster. We have shown that if enough corticosteroids are given immediately postoperatively, the risk for angle closure is not significant.
传统上，中央角膜穿孔的处理方法是采用结膜瓣、组织粘合剂、软性接触镜、角膜贴片及其他保守措施来立即保住眼球。另一种治疗方法是立即进行穿透性角膜移植术。我们展示了对25例因急性中央角膜穿孔前来就诊的患者进行立即角膜移植术的结果，其中20例源于疱疹性病变，5例因化学伤或干眼综合征所致。在所有病例中，眼球均成功保住。疱疹性穿孔的20例移植眼中有12例（60%）最终移植片清亮，而干眼或化学伤患者的5例移植眼中仅有1例（20%）如此。遇到的显著并发症包括白内障形成、继发性青光眼和持续性上皮缺损；然而，这些并发症不应妨碍最终恢复良好的视力。过去，在急性炎症和穿孔的眼中进行穿透性角膜移植术，在相当多的病例中会导致房角关闭和继发性青光眼，有时甚至会发展到彻底失败。我们已经表明，如果术后立即给予足够的皮质类固醇，房角关闭的风险并不显著。
