Ocular Surface Deficits Contributing to Persistent Epithelial Defect After Penetrating Keratoplasty
Ocular Surface Deficits Contributing to Persistent Epithelial Defect After Penetrating Keratoplasty
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穿透性角膜移植术后眼表缺陷导致持续性上皮缺损
DOI：
10.1097/ico.0b013e31821142ee
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发表时间：
2012-07-01
期刊：
影响因子：
2.8
通讯作者：
Tseng, Scheffer C. G.
中科院分区：
文献类型：
--
作者：
Fu, Yao;Liu, Jingbo;Tseng, Scheffer C. G.
目的：确定穿透性角膜移植术（PKP）后导致持续性上皮缺损（PED）的眼表缺损。方法：对 11 名 PKP 后 PED 患者的 11 只眼中导致 PED 的 4 种眼表缺损及其矫正措施进行回顾。结果：在这 11 只眼中，PKP 后 PED 发展较早的有 8 只眼，有 3 只眼的 PED 发展较晚。他们都有超过 2 处眼表缺陷，其中不频繁眨眼（11 只眼）和兔眼（9 只眼）更为常见。适当的矫正措施可在 1 周（1 只眼）、2 周（9 只眼）和 3 周（1 只眼）内实现快速上皮化，通过插入绷带隐形眼镜以维持泪膜以治疗不频繁眨眼（4 只眼）、睑裂术以纠正夜间眼球突出（2 只眼）以及穹窿重建以消除致病性睑球合（4 只眼）。在 PED 愈合后 22.1 +/- 7.6 个月的随访期间，8 只眼睛保留了稳定且清晰的移植物，而眼表缺陷较多的 3 只眼睛出现了复发性 PED 和移植物失败。其中两个通过重复 PKP 结合口腔粘膜移植来纠正剩余的疤痕眼睑。结论：除了该队列中常见的神经营养状态和水性泪液缺乏性干眼外，不频繁眨眼、眼球闭合和致病性睑球合也导致 PKP 后的 PED。在这些严重的瘢痕性眼表疾病中，适当的纠正措施和警惕的随访对于维持 PKP 移植物的存活至关重要。
Purpose: To determine the ocular surface deficits contributing to persistent epithelial defect (PED) after penetrating keratoplasty (PKP).Methods: Four ocular surface deficits that contribute to PED and their corrective measures were reviewed in 11 eyes of 11 patients with PED after PKP.Results: Among these 11 eyes, PED developed early in 8 eyes and late in 3 eyes after PKP. They all had more than 2 ocular surface deficits, with infrequent blinking (11 eyes) and lagophthalmos (9 eyes) being more common. Proper corrective measures resulted in rapid epithelialization in 1 week (1 eye), 2 weeks (9 eyes), and 3 weeks (1 eye) via insertion of a bandage contact lens to maintain tear film for treating infrequent blinking (4 eyes), tarsorrhaphy to correct nocturnal lagophthalmos (2 eyes), and fornix reconstruction to eliminate pathogenic symblepharon (4 eyes). During the follow-up of 22.1 +/- 7.6 months after healing of PED, 8 eyes retained a stable and clear graft, whereas 3 eyes with more ocular surface deficits had recurrent PED and graft failure develop. Two of the latter were corrected by a repeat PKP combined with oral mucosal graft to correct the remaining cicatricial eyelids.Conclusions: Besides the neurotrophic state and aqueous tear deficiency dry eye common in this cohort, infrequent blinking, lagophthalmos, and pathogenic symblepharon also contribute to PED after PKP. Proper corrective measures and vigilant follow-up are crucial for maintaining PKP graft survival in these severe cicatricial ocular surface diseases.