表面角膜镜片术治疗Terrienˊs边缘角膜变性初步报告

目的:探讨用表面角膜镜片术治疗严重的Terrien＇s边缘角膜变性的效果方法:全部病例为严重的周边角膜环形或部份变薄,厚度小于正常1/3,用带2mm环形巩膜的全角膜板层移植片移植到去除上皮的角膜植床。手术前及手术后定期行角膜曲率,散瞳验光检查。结果:本组病例随访时间3～13个月,平均10个月。随访期间,镜片全部透明。术前角膜散光平均11.5D,术后散光平均3.9D。术后矫正视力除一例稍降外,3例有提高。术后合并症和其它表面角膜镜片术一样,主要是镜片下混浊。本组一例因层间上皮植入性混浊位于视轴区而作了镜片更换术。结论:角膜表面镜片术治疗严重Terrien＇s边缘角膜变性,具有操作简单、方便、有效。它不但增加病变区的角膜厚度,而且手术是在角膜表面操作,不损伤Bowman氏膜,使中央角膜透明度得以保护。同时也降低角膜的散光度。眼科学报1997;13:79～81。     

准分子激光角膜切削术治疗角膜表面镜片术后散光

评价准分子激光角膜切削术治疗角膜表面镜片术后散光的效果。采用Ｃｏｈｅｒｅｎｔ产ＳＣＨＷＩＮＤＫＥＲＡＴＯＭ准分子激光治疗系统对８例１２只眼角膜表面镜片术后散光进行治疗，均为圆锥角膜术后病例，术前柱镜屈光度为－１．７５—－１０．００Ｄ，平均－５．４９Ｄ±３．２１Ｄ。术后随访６—１５月，平均１１．８月，显示裸眼视力均明显提高，矫正视力与术前相比提高者７只眼（５８．３３％）。柱镜平均屈光度由－５．４９Ｄ下降至－２．７７Ｄ，均无明显术后痛疼，术后角膜雾状混浊均不显著。说明准分子激光角膜切削术可有效地治疗角膜表面镜片术后的角膜散光，能显著地提高角膜表面镜片术治疗圆锥角膜的最终效果。     

表面角膜镜片术治疗小儿外伤性白内障术后无晶体眼的初步报告

用自制的同种材料的表面角膜镜片，对４３例（４３只眼）小儿外伤性白内障术后无晶体眼施行手术治疗，追踪时间平均２０个月，结果全部镜片透明愈合。有３１例（７２．１％）术后裸眼视力达０．２以上，３２例（７４．４％）矫正视力达０．４以上。大部分病例加载３Ｄ以下的眼镜可达术前的矫正视力，无严重并发症。表明：表面角膜镜片术是治疗小儿外伤性白内障术后无晶体眼的最好办法之一，尤其适用于不能装人工晶体的病例。     

表面角膜镜片术治疗有中央视区瘢痕的圆锥角膜

应用自制的表面角膜镜片对５例已有中央视区瘢痕的中晚期圆锥角膜者施行表面角膜镜片术，术中对４例行前房穿刺，降低眼压，以便充分地压平角膜圆锥，减低近视。结果：术后表面镜片上皮在３￣６天内完全再生，经过平均１１个月的随访，术后裸眼视力较术前提高１￣５行，平均３行。矫正视力较术前提高４￣７行，平均５行。近视较术前减少５￣１５．５Ｄ，平均１１．０Ｄ。讨论：根据本组５例的手术治疗结果，证实对于中央视区有较薄瘢     

准分子激光散光性角膜切削术治疗复合近视散光

为评价准分子激光散光性角膜切削术（ｐｈｏｔｏａｓｔｉｇｍａｔｉｃ－ｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ，ＰＡＲＫ）治疗复合性近视散光的效果，采用ｋｅｒ－ａｔｏｍⅠ型准分子激光机，利用准分子激光对角膜浅表层的椭圆形切削，共对５７例８２只复合近视散光眼行治疗，随访１年以上。术前近视球镜平均为－６．２３±２．５０Ｄ，散光为－１．４７±０．８２Ｄ，角膜散光为１．２１±０．４８Ｄ，最佳矫正视力为０．９７±０．１５。结果：术后视力和屈光状态在３～６个月趋于稳定，术后１年随访，近视平均为－０．５２±１．００Ｄ，散光为－０．４３±０．４３Ｄ，相比术前散光平均降低７０．７％；在术前散光≤０．７５Ｄ、１．００～１．７５Ｄ及≥２．００Ｄ三组中，其术后散光分别比术前降低６０．３％、７０．０％和７４．９％，术后角膜散光平均为０．７２±０．２７Ｄ，比术前降低４０．５％；术后裸眼视力：９０．２％达到０．５或以上，７２％达到０．８或以上。无严重手术并发症。结论：ＰＡＲＫ是矫治散光的有效安全方法，主要用于矫正由规则对称角膜散光引起的复合近视散光     

后房型人工晶体植入术后角膜散光及其控制方法

本文对８０例后房型人工晶体植入术前后的角膜散光变化观察并采取控制方法表明：术后角膜的循规性散光于术后２周平均增加５Ｄ，术后３个月平均减至２Ｄ。术中调节缝线的中张力，术后２周至３个月选择性拆除角膜缝线和无缝线巩膜隧道式切口等都控制术后角膜散光的有效措施。我们提出了综合控制术后角膜散光产生的方法。     

表面角膜镜片术联合白内障摘除术的临床研究

将无明显角膜散光（≤１．００ＤＣ）的白内障病人１５例施行表面角膜镜片术联合白内障摘除术（Ⅰ期手术），另将无明显角膜散光（≤１．００ＤＣ）的无晶体眼病人１９例施行表面角膜镜片术（Ⅱ期手术）。术后二组病人裸眼视力的提高程度相似；角膜屈光度增加分别为９．７７±２．８４Ｄ和９．８４±２．３５Ｄ；发生明显角膜散光（＞１．００ＤＣ）者分别为９例（６０％）和１０例（５２．６３％），二组间均无显著性差异（Ｐ＞０．０５）。术后二组病人屈光效应稳定时间分别为５．３７±０．８４个月及４．４５±１．０５个月，有显著性差异（Ｐ＜０．０１）。研究结果表明表面角膜镜片术联合白内障摘除术是可行的。     

自动板层角膜成形联合准分子激光角膜切削术治疗高度近视

目的 评价自动板层角膜成形联合准分子激光角膜切削术（ＡＬＫ－Ｅ）治疗高度近视的效果。方法 用自动板层角膜刀和Ｋｅｒａｃｏｒ１１６型准分子激光机对４０例（４７只眼）行ＡＬＫ－Ｅ，术后随访３个月以上。术前屈光度（球面等量）平均为１４．５５±５．１４Ｄ（－８．００￣－３０．００Ｄ），其中散光最高为７．００Ｄ。结果 术前屈光度及裸眼视力约在１个月趋于稳定。术前屈光度－１５．００Ｄ以下，在术后３个月的平均     

准分子激光角膜切削术治疗近视和近视散光的临床观察

观察准分子激光角膜切削术治疗近视和近用光的临床结果。方法３０７例５５８只眼按术前散光度数分４组，Ⅰ组：１６８只眼，无散光；Ⅱ组：２６８只眼，散光－０．２５－－１．００Ｄ；Ⅲ组：８７只眼，散光－１．２５－－２．００Ｄ；Ⅳ组：３５只眼，散光－２．２５－－４．２５Ｄ。全部病例术后随访６个月以上。     

二次放射状角膜切开术

对３８例（５９只眼）接受二次放射状角膜切开术，二次切口沿旧切痕完成，随访时间平均１３个月。术前平均等效球镜屈光为－３．７８Ｄ，解膜屈光度为４０．１５Ｄ。术后平均下降等效球镜为２．３０Ｄ，下降角膜屈光２．０４，平均提高裸眼视力５行（国际标准视力表）。二次手术疗效与原屈光度及二次术前角膜屈光度无关。二次手术可降低散光度，并发症少。     

Two cases of Terrien's marginal degeneration treated with peripheral full thickness keratectomy,and followed-up by computer-assisted corneal topography

BACKGROUND: In 1970 Alberth and Süveges published a method, peripheral full thickness keratectomy, for the treatment of Terrien's marginal degeneration of the cornea. They hypothesized that this type of surgery acts by excising the thinned and extended corneal parts and by restoring normal corneal surface and curvature. METHOD: The right eyes of two patients with Terrien's disease were operated with full thickness keratectomy at our Department, and were followed-up by computer-assisted computer topography. RESULTS: The corneal surface became more regular, astigmatism smaller and fully correctable, visual acuity improved, and the results did not change between 1 and 3 years after surgery in either of the two cases. CONCLUSION: Peripheral full thickness keratectomy, in our experience, proved effective in reducing astigmatism, in improving visual acuity, and in stopping the progression of the disease. Corneal topography can be used in the diagnosis of Terrien's disease, as well as in the postoperative follow-up of patients, giving more information than simple keratometry.     

Descemet's stripping with endothelial keratoplasty in 50 eyes: a refractive neutral corneal transplant

PURPOSE: To evaluate early visual and refractive outcomes following treatment of corneal endothelial dysfunction with a corneal transplantation technique, Descemet's stripping with endothelial keratoplasty (DSEK). METHODS: Visual and refractive outcomes of the first 50 consecutive cases of DSEK performed by a single surgeon between December 2003 and July 2004 were analyzed retrospectively. The DSEK technique consisted of stripping Descemet's membrane and endothelium from a recipient cornea and transplanting the posterior stroma and endothelium of a donor cornea through a 5-mm incision. RESULTS: Results are reported for 50 eyes in 47 patients (30 women and 17 men). Mean patient age at surgery was 70 +/- 12 years (range: 34 to 89 years). Five eyes were treated for corneal edema or bullous keratopathy and 45 for Fuchs' endothelial dystrophy. Seven eyes were phakic and 43 were pseudophakic. Six months after surgery, mean manifest cylinder was 1.5 +/- 0.94 diopters (D), unchanged from preoperative cylinder of 1.5 +/- 1.0 D. Mean manifest spherical equivalent refraction was 0.15 +/- 1.5 D at 6-month follow-up compared with -0.36 +/- 1.4 D preoperatively (P = .10) At 3- and 6-month follow-up, significant improvement was noted in mean best spectacle-corrected visual acuity compared with the preoperative mean of 20/100 (P = .007). At 6-month follow-up, 31 (62%) eyes refracted to > or = 20/40 and 38 (76%) eyes saw > or = 20/50. CONCLUSIONS: Compared to standard penetrating keratoplasty, DSEK causes minimal refractive change and provides rapid visual recovery for patients with endothelial dysfunction. This technique maintains the structural integrity of the cornea by preserving the recipient's epithelium, Bowman's layer, and entire stromal thickness.     

Terrien＇s边缘部变性的角膜地形图

报告２例３眼Ｔｅｒｒｉｅｎ＇ｓ边缘部变性的角膜地形图改变。发现此病角膜地形图呈不对称蝴蝶结形及逆规性散光。此病早期特征为角膜病变处局部屈光度明显大于正常。治疗性表面角膜镜片术是此病的较好治疗方法。     

Long-term stability of the posterior cornea after laser in situ keratomileusis

PURPOSE: To study long-term changes in posterior corneal elevation after laser in situ keratomileusis (LASIK) using Scheimpflug topography (Pentacam, Oculus, Inc.) in eyes 1 year after LASIK. SETTING: Department of Ophthalmology, Albany Medical Center, and a private practice, Albany, New York, USA. METHODS: One hundred two myopic eyes of 52 consecutive patients presenting for their 1-year follow-up were prospectively evaluated using the Pentacam to determine elevation changes to the posterior corneal surface between preoperative and 1-year postoperative measurements. Changes in posterior elevation were performed by comparing the best-fit sphere preoperatively and postoperatively with a fixed reference sphere determined by the central 9.0 mm preoperative cornea. Statistical and graphical analyses were performed. RESULTS: One hundred two post-LASIK eyes (mean correction -4.33 diopters; mean ablation depth 68.70 microm; mean estimated residual bed thickness 327 microm) had a mean posterior displacement of -0.47 microm +/- 3.48 (SD) (range -10.0 to +7 microm). The mean follow-up period was 13.6 months (range 8.8 to 19.3 months). CONCLUSIONS: In this population, no patient had significant forward protrusion of the posterior corneal surface a mean of 14 months after LASIK. The posterior cornea in post-LASIK myopic eyes was very stable. Contrary to results in previous studies, progressive changes to the posterior corneal surface did not routinely occur after LASIK performed within established parameters.     

Ring-shaped corneoscleral lamellar keratoplasty guided by high-definition optical coherence tomography and Scheimpflug imaging for severe Terrien’s marginal corneal degeneration

Background

To evaluate the clinical efficacy of ring-shaped corneoscleral lamellar keratoplasty under guidance of high-definition optical coherence tomography (HD-OCT) and Scheimpflug imaging for severe Terrien’s marginal corneal degeneration.

Methods

Twenty-five patients (25 eyes) with Terrien's marginal corneal degeneration and?≥?6 diopters of astigmatism were treated at the Shandong Eye Institute from January 2008 through December 2010. In these patients, the diseased area was?>?1 quarter of the cornea, and the thickness at the thinnest corneal area was?<?150?μm with residual corneal stroma. Ring-shaped corneoscleral lamellar keratoplasty was performed, and the depth and width of dissection was set according to the HD-OCT and Pentacam examinations. Data of complications, surgical effects, visual acuity, and astigmatism were collected.

Results

No intraoperative corneal perforation occurred. No patients had liquid accumulation between the graft and the recipient. At 1?year after surgery, the average best-corrected visual acuity improved to 6/9 from preoperative 6/36, and the average astigmatism reduced to 4.37 (2.04) diopters from preoperative 13.39 (7.52) diopters. There was no recurrence of the disease or corneal graft rejection in the follow-up period.

Conclusions

Ring-shaped corneoscleral lamellar keratoplasty guided by HD-OCT and Pentacam imaging appears to be effective in the treatment of severe Terrien’s marginal corneal degeneration. Surgical perforation can be significantly reduced.     

Excimer laser-assisted anterior lamellar keratoplasty for keratoconus, corneal problems after laser in situ keratomileusis, and corneal stromal opacities

PURPOSE: To evaluate excimer laser-assisted anterior lamellar keratoplasty to augment thin corneas as in keratoconus (<350 microm) and corneal ectasia after laser in situ keratomileusis (LASIK) and to treat anterior stromal opacities. SETTING: Ophthalmology Department, School of Medicine, Gazi University, Ankara, Turkey. METHODS: Thirteen eyes (5 keratoconus, 3 macular dystrophies, 1 post-LASIK ectasia, 1 post-LASIK interstitial keratitis, 3 post-herpetic keratitis sequelae) of 13 patients were included in this prospective study. The treatment group was divided into corneal ectasia and stromal opacity groups. A donor stromal button approximately 350 microm thick received a 100 microm excimer laser ablation on the endothelium. The remaining cornea (epithelium, Bowman's membrane, and stroma) was punched with a 7.5 or 7.7 mm trephine. After transepithelial ablation of the host cornea to 200 mum thickness, the corneal button was sutured with interrupted 10-0 monofilament nylon. Sutures were removed between 3 months and 6 months postoperatively. Preoperative and postoperative simulated keratometric cylinders and corneal thickness values were compared using the Wilcoxon signed rank test. The postoperative spherical equivalent refraction and best spectacle-corrected visual acuity (BSCVA) between the groups were compared using the Mann-Whitney U test. RESULTS: The mean follow-up was 27.6 months +/- 8.3 (SD). All patients gained 2 lines or more of BSCVA, and no patient lost a line. The mean corneal thickness was 381.2 +/- 88.2 microm preoperatively, which significantly increased to 534.9 +/- 96.6 microm postoperatively (P < .05). The mean preoperative simulated keratometric cylinder was 7.44 +/- 7.18 diopters (D); postoperatively, it decreased to 2.61 +/- 1.73 D (P < .05). There was no significant difference in postoperative spherical equivalent refraction or BSCVA between the groups (P > .05). CONCLUSIONS: This technique presents a different modality for the treatment of keratoconus, post-LASIK corneal problems, and other corneal stromal opacities with anterior lamellar keratoplasty. Additional studies with more patients and longer follow-up will help determine the role of this technique as a substitute for penetrating keratoplasty in these patients.     

Treatment of corneal dermoid with lenticules from small incision lenticule extraction surgery: a surgery assisted by fibrin glue

AIM: To observe the clinical efficacy of the combined use of small incision lenticule extraction (SMILE)-derived lenticule patches in corneal dermoid excision, with fixation of the lenticule patches assisted by fibrin glue. METHODS: Seventeen eyes of 17 patients with corneal dermoid were treated with dermoid removal combined with SMILE-derived lenticule transplantation. All lenticule patches were fixed by fibrin glue. Ocular changes were assessed using slit lamp microscopy and anterior-segmental optical coherence tomography. The best-corrected visual acuity (BCVA) and ocular dioptric variations were examined preoperatively and postoperatively. Intraocular pressure (IOP) was also monitored in all visited time. RESULTS: Totally, 18 lenticule patches were used on 17 eyes of 17 cornea dermoid patients. The mean follow-up time was 11.47±5.28mo. All lenticule patches were successfully glued, kept on its location and maintained transparent during the follow-up time, with a consecutive epithelial cover for 1wk. Nine of the patients could coordinate visual and optometry exam well. Their preoperative BCVA is 0.60±0.35 in decimal, significantly improved to 0.80±0.26 in decimal at 6mo postoperatively (Z=-2.392, P=0.017), but the changes of their corneal astigmatism diopters showed no significance, with 2.22±1.91 D preoperatively, and 2.28±1.31 D at 6mo postoperatively (Z=-0.135, P=0.893). Limbal pannus formation occurred in 4 (23.52%) cases and decreased with the application of tacrolimus eyedrops. IOP increased in 2 (11.76%) cases, but well decreased by timolol maleate eyedrops. All the adult patients or guardians of minor patients were satisfied with the cosmetic improvement. CONCLUSION: Dermoid excision combined with transplantation of SMILE-derived lenticule patches using fibrin glue is a safe and effective novel tectonic keratoplasty procedure for corneal dermoid.     

Absence of keratectasia after LASIK in eyes with preoperative central corneal thickness of 450 to 500 microns

PURPOSE: To determine whether preoperative central corneal thickness less than or equal to 500 microm is an independent risk factor for development of keratectasia following LASIK. METHODS: Chart review was performed for 109 eyes with preoperative central corneal thickness of 452 to 500 microm in 69 patients who underwent LASIK between September 2000 and July 2005 and had no known risk factors for keratectasia. All eyes included in this analysis had postoperative manifest refractions at follow-up at 1-month and 12-months or greater (median: 452 days; range: 365 to 1980 days). RESULTS: Attempted correction (spherical equivalent refraction) ranged from +3.13 to -7.75 diopters. There were no clinical signs of keratectasia at any postoperative visits in the 109 eyes in this study. There was no statistically significant change in mean spherical equivalent or manifest cylinder from the 1-month follow-up examination to the last documented visit (12 months or greater). No correlation was found for preoperative pachymetry and refractive change between postoperative examinations at 1 month and 12 months or greater. Double-angle vector analysis determined the directional shift in postoperative refractive cylinder was not statistically significant from zero (P > .05). CONCLUSIONS: In this group of 109 LASIK-treated eyes with preoperative central corneal thickness less than or equal to 500 microm that were screened for known keratectasia risk factors, there was no evidence of postoperative keratectasia.     

角膜塑形术治疗青少年近视疗效探讨

目的：评价角膜塑形术（Ｏｒｔｈｏｋｅｒａｔｏｌｏｇｙ）治疗青少年近视的效果。方法：应用角膜塑形术治疗５６例青少年近视患者共１１０眼。分为３组：Ⅰ组为－１．００～－３．００Ｄ,Ⅱ组为－－３．２５～－６．００Ｄ,Ⅲ组为－６．２５～－７．５０Ｄ,随访３个月。将各个时期的裸眼视力、屈光度、角膜屈光力与术前进行比较。同时,对治疗３个月后的角膜屈光力变化值（Ｘ）值与临床屈光度变化值（Ｙ）进行直线回归及直线相关