Lamellar Keratoplasty Following Thermokeratoplasty in the Treatment of Acute Corneal Hydrops
Lamellar Keratoplasty Following Thermokeratoplasty in the Treatment of Acute Corneal Hydrops
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热角膜移植术后的板层角膜移植治疗急性角膜积水
DOI：
10.1016/j.ajo.2014.03.011
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发表时间：
2014-07-01
影响因子：
4.2
通讯作者：
Shi, Weiyun
中科院分区：
文献类型：
--
作者：
Li, Suxia;Liu, Mingna;Shi, Weiyun
目得：目的观察前房穿刺联合角膜热成形术治疗圆锥角膜急性水肿的疗效。设计：回顾性临床病例系列。方法：对21例（21眼）圆锥角膜急性水肿患者行前房穿刺联合角膜热成形术。在水肿吸收、后弹力膜破裂和间质裂隙治愈后1周，所有患者接受改良DALK。记录手术期间后弹力层再次破裂（如果有的话）。结果：前房穿刺联合角膜热移植术后1周内，所有患者角膜水肿迅速减轻，基质层裂隙明显缩小。所有患者均在首次手术后2周内成功进行DALK，无后弹力层再破或角膜穿孔。7眼受体完全透明，14眼受体中心出现轻度梭形瘢痕。术后6个月后弹力膜破裂处混浊均减轻或消失。DALK术后1年，平均最佳矫正视力提高至20/30。结论：前房穿刺联合角膜热成形术可加速急性角膜水肿（1周内）和后弹力层破裂无明显混浊（2周内）患者角膜水肿的吸收。在这个窗口期，DALK可以安全地进行，并且可以获得良好的视力。(C)2014年，Elsevier Inc. All rights reserved.
PURPOSE: To observe the efficacy of deep anterior lamellar keratoplasty (DALK) for treatment of acute hydrops in keratoconus after anterior chamber paracentesis combined with thermokeratoplasty.DESIGN: Retrospective, noncomparative clinical case series.METHODS: Twenty-one patients (21 eyes) suffering acute hydrops associated with keratoconus were treated first by anterior chamber paracentesis combined with thermokeratoplasty. At 1 week after the edema was absorbed, and Descemet membrane ruptures and stromal clefts were cured, all patients received modified DALK. Descemet membrane re-ruptures during surgery were recorded, if any. Graft transparency, visual acuity, recipient folds or opacity, and immune rejection were monitored for 6 months to 1 year.RESULTS: All the corneal edema alleviated rapidly, and the intrastromal clefts narrowed within 1 week after combined anterior chamber paracentesis and thermokeratoplasty. DALK was performed successfully in all patients within 2 weeks after the first surgical procedure, with no Descemet membrane rebreaking or corneal perforation. The recipients were completely clear in 7 eyes, and mild fusiform scars appeared at the central recipient in 14 eyes. All the opacity of Descemet membrane ruptures became slight or even disappeared after 6 months. The mean best-corrected visual acuity was improved to 20/30 at 1 year after DALK. No immune rejection occurred.CONCLUSIONS: Anterior chamber paracentesis combined with thermokeratoplasty can accelerate the absorption of corneal edema in patients with acute corneal hydrops (within 1 week) and Descemet membrane rupture healing without obvious opacity (within 2 weeks). During this window phase, DALK could be performed safely, and good visual acuity may be obtained. (C) 2014 by Elsevier Inc. All rights reserved.