Bull H, Behrens-Baumann W
Klinik für Augenheilkunde, Otto-von-Guericke-Universität Magdeburg.
Klin Monbl Augenheilkd. 1997 Feb;210(2):78-81. doi: 10.1055/s-2008-1035020.
To compare the outcome of epikeratoplasty vs. penetrating keratoplasty in patients with corneal ulcer.
24 patients had been treated by an epikeratoplasty and 20 patients by a penetrating keratoplasty within 5 years. The indication to operate was progression of a corneal ulcer, perforated ulcer or a descemetocele. In epikeratoplasty a complete cornea with adjacent scleral rim was fixed upon the recipient eye by scleral sutures. This transplant was removed after some weeks. In both groups the patients were reexamined and the anatomical and functional outcome was registered.
In both groups all but one globe could be saved. The integrity of corneal surface was restored in 85% (n = 17) of the keratoplasty group and in 75% (n = 18) in epikeratoplasty. The vascularization of the cornea after removing the transplant in epikeratoplasty patients was increased by 70% (n = 17) and their corneas revealed more opacification than before. In the penetrating keratoplasty patient group the vascularization increased in 40% (n = 8) and in 20% (n = 4) of the patients the transplant became cloudy. The visual acuity improved in 13 cases in penetrating keratoplasty but only in two cases after epikeratoplasty.
A corneal ulcer (with or without perforation) treated by a penetrating keratoplasty with removing the ulcerated tissue has a better outcome than an ulcer covered by an epikeratoplasty. In patients only able to tolerate a short time of surgery with minimal operative risk or if there is no possibility of microsurgical treatment epikeratoplasty may be an alternative to penetrating keratoplasty in saving the globe. However, in most patients penetrating keratoplasty has better functional results.
比较角膜溃疡患者接受表层角膜镜片术与穿透性角膜移植术的效果。
5年内，24例患者接受了表层角膜镜片术治疗，20例患者接受了穿透性角膜移植术治疗。手术指征为角膜溃疡进展、穿孔性溃疡或后弹力层膨出。在表层角膜镜片术中，将带有相邻巩膜缘的完整角膜通过巩膜缝线固定于受体眼上。数周后移除该移植片。两组患者均接受复查，并记录解剖学和功能学结果。
两组中除1只眼球外，其余均得以挽救。穿透性角膜移植术组85%（n = 17）的患者角膜表面完整性得以恢复，表层角膜镜片术组为75%（n = 18）。表层角膜镜片术患者移除移植片后角膜血管化增加了70%（n = 17），且角膜混浊比之前更明显。穿透性角膜移植术患者组中，40%（n = 8）的患者血管化增加，20%（n = 4）的患者移植片变得混浊。穿透性角膜移植术患者中有13例视力改善，而表层角膜镜片术后仅2例视力改善。
通过切除溃疡组织进行穿透性角膜移植术治疗角膜溃疡（无论有无穿孔），其效果优于表层角膜镜片术覆盖溃疡的情况。对于仅能耐受短时间手术且手术风险极小的患者，或如果没有显微手术治疗的可能性，表层角膜镜片术在挽救眼球方面可能是穿透性角膜移植术的一种替代方法。然而，在大多数患者中，穿透性角膜移植术具有更好的功能结果。
