Killingsworth D W, Stern G A, Driebe W T, Knapp A, Dragon D M
Department of Ophthalmology, University of Florida College of Medicine, Gainesville 32610-0284.
Ophthalmology. 1993 Apr;100(4):534-41. doi: 10.1016/s0161-6420(13)31631-5.
To determine the anatomic and visual results of therapeutic penetrating keratoplasty (PK) and its role in the management of corneal disease.
The authors reviewed the records of all of their patients who had undergone therapeutic PK over the past 9 years and evaluated each for the following criteria: cure of disease, graft clarity, and visual acuity. Patients were divided into seven categories: (1 and 2) bacterial and fungal keratitis, (3 and 4) herpetic keratitis, with and without inflammation, (5) acanthamoebic keratitis, (6) perforations due to keratoconjunctivitis sicca, and (7) other causes of perforation.
In microbial keratitis, therapeutic PK eradicated the disease in all cases. Seventy-three percent of grafts for bacterial keratitis and 60% for fungal keratitis remained clear. A higher percentage of clarity was achieved when grafts were 9.0 mm or less. Seven patients with secondary endophthalmitis were cured with a surgical approach including therapeutic PK. In herpetic keratitis with active inflammation, only 36% of grafts remained clear, and inflammation recurred in 36%. All perforations due to post-herpetic persistent epithelial defects in "quiet" eyes were grafted successfully. In patients with severe keratoconjunctivitis sicca, eyes were anatomically stabilized in 83%, but all grafts failed because of complications from ocular surface disease.
Therapeutic PK is valuable in the management of microbial keratitis that does not respond to antimicrobial therapy. Results are poorer for patients with herpetic keratitis, although selected patients respond to therapeutic PK when other methods of management have failed. Patients with perforations due to keratoconjunctivitis sicca have a uniformly poor prognosis for graft clarity.
确定治疗性穿透性角膜移植术（PK）的解剖学和视觉效果及其在角膜疾病治疗中的作用。
作者回顾了过去9年中所有接受治疗性PK的患者记录，并根据以下标准对每位患者进行评估：疾病治愈情况、植片清晰度和视力。患者分为七类：（1和2）细菌性和真菌性角膜炎，（3和4）有炎症和无炎症的疱疹性角膜炎，（5）棘阿米巴角膜炎，（6）干燥性角结膜炎导致的穿孔，以及（7）其他穿孔原因。
在微生物性角膜炎中，治疗性PK在所有病例中均根除了疾病。细菌性角膜炎的植片73%保持清晰，真菌性角膜炎的植片60%保持清晰。植片直径为9.0毫米或更小的时候，清晰度更高。7例继发性眼内炎患者通过包括治疗性PK在内的手术方法治愈。在有活动性炎症的疱疹性角膜炎中，只有36%的植片保持清晰，36%炎症复发。“安静”眼中所有因疱疹后持续性上皮缺损导致的穿孔均成功进行了植片手术。在严重干燥性角结膜炎患者中，83%的眼睛在解剖学上得到稳定，但由于眼表疾病并发症，所有植片均失败。
治疗性PK在治疗对抗菌治疗无反应的微生物性角膜炎方面很有价值。疱疹性角膜炎患者的结果较差，尽管在其他治疗方法失败时，部分患者对治疗性PK有反应。干燥性角结膜炎导致穿孔的患者，植片清晰度的预后普遍较差。
