Adult keratoplasty: has the prognosis improved in the last 25 years?
Adult keratoplasty: has the prognosis improved in the last 25 years?
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DOI：
10.1007/s10792-007-9183-1
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发表时间：
2008-06-01
影响因子：
1.6
通讯作者：
Price, Marianne O.
中科院分区：
文献类型：
--
作者：
Price, Francis W.;Price, Marianne O.
在过去的四分之一世纪里，由于新的药物、先进的手术设备、对导致移植失败的原因的更好理解，以及选择性地只更换病变角膜层的靶向技术，成人角膜移植的效果有了显著改善。长期以来，移植排斥反应一直是导致移植失败的主要原因，随着创新的局部和全身免疫抑制剂的发展，移植排斥反应的预防和治疗得到了改善。预防和治疗眼表并发症的新方法已经被设计出来，角膜缘干细胞移植显著改善了严重眼表疾病的治疗。改进的人工晶状体设计减少了角膜损伤，增加了角膜移植的存活率。非甾体抗炎（NSAID）滴眼液和更彻底的玻璃体切除术降低了慢性囊样黄斑水肿的发生率，这可能会阻止透明移植的眼睛恢复有用的视力。圆锥角膜或角膜疤痕患者现在可以从先进的前板层角膜移植术中获益，这种技术可以降低免疫排斥和内皮细胞衰竭的风险，同时达到穿透性角膜移植术的视力效果。内皮功能障碍的患者现在可以从先进的内皮角膜移植术中获益，这种技术可以提供更快的视力恢复，最大限度地减少诱发散光和眼表问题，并且几乎消除了小创伤造成的伤口破裂的风险。最后，飞秒激光现在为移植外科医生提供了一种精确的工具，可以创造复杂的、互锁的角膜切口，从而促进伤口愈合。
Adult keratoplasty outcomes have significantly improved in the past quarter century as a result of new pharmaceuticals, advanced surgical devices, better understanding of what causes graft failure, and targeted techniques for selective replacement of only diseased corneal layers. Prevention and treatment of graft rejection, which has long been a leading cause of graft failure, has improved with the development of innovative topical and systemic immuno-suppressants. New methods for preventing and treating ocular surface complications have been devised, and limbal stem cell grafts have significantly improved management of severe ocular surface disease. Improved intraocular lens designs cause less corneal damage and have increased corneal graft survival. Non-steroidal anti-inflammatory (NSAID) eyedrops and more complete vitrectomies have reduced the incidence of chronic cystoid macular edema, which could prevent eyes with clear grafts from regaining useful vision. Patients with keratoconus or corneal scars can now benefit from advanced anterior lamellar keratoplasty techniques, which reduce the risk of immunologic rejection and endothelial failure, while matching the visual outcomes achieved with penetrating keratoplasty. Patients with endothelial dysfunction can now benefit from advanced endothelial keratoplasty techniques, which provide more rapid visual recovery, minimize induced astigmatism and ocular surface problems, and virtually eliminate the risk of wound rupture from minor trauma. Finally, femtosecond lasers now provide transplant surgeons with a precise tool for creating complex, interlocking corneal incisions that may facilitate wound healing.