Panda A, Khokhar S, Rao V, Das G K, Sharma N
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Ophthalmic Surg. 1995 Jul-Aug;26(4):325-9.
Results of penetrating keratoplasty in 443 eyes of 439 patients of active infective corneal ulcers, from a period of 10 years, were analyzed. All these eyes were proven refractory to maximal medical therapy for extended periods of time, in some cases more than 6 weeks. As the surgery was performed during the active stage, the outcome was not favorable functionally. Clinical cure was obtained, however, by therapeutic penetrating keratoplasty in all but 27 of these eyes. Of unsuccessful cases, 16 could be saved with additional medical therapy, two led to phthisis bulbi, and nine required repeat therapeutic penetrating keratoplasty. Complications encountered included disturbances in intraocular dynamics such as extrusion of the lens and vitreous during surgery, secondary rise of intraocular pressure leading to damage of the optic nerve, loss of the eye due to above factors, and reinfection. The anatomical success achieved was 97% with graft clarity of 2+ or more in 39% of eyes. Useful vision, ie, better than or equal to 6/60, was possible in 33% of eyes. Thus, therapeutic keratoplasty in refractory corneal ulcer still has scope in a Third-World country.
对439例活动性感染性角膜溃疡患者的443只眼进行了为期10年的穿透性角膜移植术结果分析。所有这些眼睛经长时间最大程度的药物治疗均被证明无效，在某些情况下超过6周。由于手术是在活动期进行的，功能结果并不理想。然而，除27只眼外，所有这些眼睛通过治疗性穿透性角膜移植术均实现了临床治愈。在未成功的病例中，16只眼经额外药物治疗得以挽救，2只眼导致眼球痨，9只眼需要再次进行治疗性穿透性角膜移植术。遇到的并发症包括眼内动力学紊乱，如手术期间晶状体和玻璃体脱出、眼压继发性升高导致视神经损伤、因上述因素导致眼球丧失以及再次感染。解剖学成功率为97%，39%的眼睛移植片清晰度为2+或更高。33%的眼睛可获得有用视力，即视力优于或等于6/60。因此，在第三世界国家，难治性角膜溃疡的治疗性角膜移植术仍有应用空间。
