Ariyasu R G, Silverman J, Irvine J A
Doheny Eye Institute, Los Angeles, California 90033.
Cornea. 1994 Nov;13(6):521-6.
The efficacy of corneal transplantation in infants with corneal opacity secondary to congenital glaucoma has not been established. We retrospectively reviewed our results of nine penetrating keratoplasties performed on eight eyes of six infants who had multiple risk factors for poor prognosis: age < 2 years at the time of grafting; uncontrolled glaucoma in four eyes; concurrent lensectomy, retinal, or glaucoma surgery in five eyes; aphakia in five eyes; and an acute perforation in one eye. Six of the nine grafts (67%) remained clear during a mean follow-up of 24 months (30 months in eyes with clear grafts). Development of ambulatory vision or better occurred in six of eight (75%) eyes after corneal transplantation and treatment of refractive errors and amblyopia. Graft failure occurred in three eyes--two from corneal decompensation, and one from homograft rejection. Complications included one total retinal detachment, one case of Streptococcus pneumoniae keratitis, and three cases that lost intraocular pressure control, requiring further glaucoma surgery. We conclude that useful vision can be achieved after penetrating keratoplasty even in some high-risk infants with congenital glaucoma.
角膜移植术对先天性青光眼继发角膜混浊婴儿的疗效尚未确定。我们回顾性分析了对6例婴儿8只眼施行的9次穿透性角膜移植术的结果，这些婴儿存在多种预后不良的危险因素：移植时年龄小于2岁；4只眼青光眼未得到控制；5只眼同时进行了晶状体切除术、视网膜手术或青光眼手术；5只眼无晶状体；1只眼急性穿孔。9次移植中有6次（67%）在平均24个月的随访期内保持透明（移植透明的眼为30个月）。角膜移植并矫正屈光不正及弱视后，8只眼中有6只（75%）获得了可走动视力或更好的视力。3只眼发生移植失败，2只因角膜失代偿，1只因同种异体移植排斥反应。并发症包括1例完全性视网膜脱离、1例肺炎链球菌性角膜炎以及3例眼压控制不佳，需进一步行青光眼手术。我们得出结论，即使是一些患有先天性青光眼的高危婴儿，穿透性角膜移植术后也可获得有用视力。
