Buzard K A, Fundingsland B R
Buzard Eye Institute, Las Vegas, Nevada, USA.
J Cataract Refract Surg. 1997 Apr;23(3):398-406. doi: 10.1016/s0886-3350(97)80184-8.
To evaluate the results and complications rates associated with corneal transplantation for keratoconus and assess the prospects of using penetrating keratoplasty at a much earlier stage.
Buzard Eye Institute, Las Vegas, Nevada, USA.
In this prospective clinical study, 104 eyes of 76 patients had corneal transplantation for keratoconus identified by corneal topography, keratometry, pachymetry, and/or retinoscopy. Sutures were removed at a mean of 15 months; mean follow-up was 42 months. All surgeries were performed by one surgeon using a torque-antitorque suture method. Eyes were grouped according to severity of the disease: early (n = 24); moderate (n = 47); high (n = 33). Preoperative keratometry was 40.00 to 49.00, 50.00 to 59.00, and 60.00 to 90.00 diopters (D), respectively. The criteria for corneal transplant were a best spectacle-corrected visual acuity of 20/40 or worse and keratoconus clearly identified by one of the above methods. Secondary procedures included repair of wound dehiscence (33 eyes, 31%), relaxing incisions (33 eyes, 31%), wedge resections (5 eyes, 5%), and automated lamellar keratoplasty (4 eyes, 4%).
Mean postoperative uncorrected visual acuity at last follow-up was 0.43 +/- 0.3 (20/50), with 46 eyes (44%) achieving 20/40 or better. Mean best corrected visual acuity (BCVA) at last follow-up was 0.83 +/- 0.2 (20/25). Sixty eyes (58%) achieved 20/40 or better BCVA at 1 month and 92 eyes (88%), at 3 months. At last follow-up, mean average keratometric astigmatism was 3.10 +/- 1.70 D, mean keratometry was 43.30 +/- 2.20 D, and mean spherical equivalent was -1.70 +/- 3.00 D. Complications included 21 graft rejections (20%); 19 were successfully treated with topical and oral steroids. No expulsive hemorrhage or endophthalmitis occurred.
The risk-benefit for corneal transplantation has been significantly altered by improved surgical and postoperative techniques. The improved results, low complication rate, and postoperative enhancement management indicate that corneal transplantation is a viable option early in the clinical course of keratoconus.
评估圆锥角膜角膜移植的结果及并发症发生率，并评估在更早阶段进行穿透性角膜移植的前景。
美国内华达州拉斯维加斯的布扎德眼科研究所。
在这项前瞻性临床研究中，通过角膜地形图、角膜曲率计、角膜厚度测量和/或检影法确定76例患者的104只眼睛因圆锥角膜接受了角膜移植。缝线平均在15个月时拆除；平均随访时间为42个月。所有手术均由一名外科医生采用抗扭矩缝线法进行。根据疾病严重程度对眼睛进行分组：早期（n = 24）；中度（n = 47）；重度（n = 33）。术前角膜曲率分别为40.00至49.00、50.00至59.00和60.00至90.00屈光度（D）。角膜移植的标准是最佳矫正视力为20/40或更差，且通过上述方法之一明确诊断为圆锥角膜。二次手术包括伤口裂开修复（33只眼，31%）、松解切口（33只眼，31%）、楔形切除术（5只眼，5%）和自动板层角膜成形术（4只眼，4%）。
最后一次随访时的平均术后未矫正视力为0.43±0.3（20/50），46只眼（44%）达到20/40或更好。最后一次随访时的平均最佳矫正视力（BCVA）为0.83±0.2（20/25）。60只眼（58%）在1个月时BCVA达到20/40或更好，92只眼（88%）在3个月时达到。在最后一次随访时，平均角膜散光为3.10±1.70 D，平均角膜曲率为43.30±2.20 D，平均球镜等效度为-1.70±3.00 D。并发症包括21例移植排斥反应（20%）；19例通过局部和口服类固醇成功治疗。未发生暴发性出血或眼内炎。
手术技术和术后技术的改进显著改变了角膜移植的风险效益比。改善的结果、低并发症发生率和术后强化管理表明，角膜移植在圆锥角膜临床病程早期是一种可行的选择。
