改进的巩膜嵌顿术治疗难治性青光眼

目的探讨板层巩膜嵌顿术治疗难治性青光眼的疗效.方法难治性青光眼共28例(28眼).其中新生血管性青光眼16例,2次以上小梁切除手术者9例,无晶状体眼青光眼3例.术后随访观察虹膜新生血管、眼压和视力变化.结果随访6～12月者10例,12月以上者16例,失访2例.新生血管性青光眼患者的虹膜及前房角新生血管术后完全消退.眼压全部降到30mmHg(1mmHg=0.133 kPa)以下,21 mmHg以下者24眼.术后发现脉络膜脱离者5眼,经皮质类固醇治疗均恢复正常.结论巩膜嵌顿术是治疗难治性青光眼的一种有效的方法.     

脉络膜上腔引流术治疗难治性青光眼

目的 探讨脉络膜上腔引流术治疗难治性青光眼的疗效。方法 临床诊断为难治性青光眼的患者28例28眼，其中新生血管性青光眼16例，无晶状体青光眼3例，先天性青光眼2次以上小梁切除术后9例。术前眼压41．38—94．32mmHg(1kPa＝7．5mmHg)，平均57．42mmHg。所有患者术后随访观察症状、虹膜新生血管、眼压和视力变化。结果 随访12个月以上者17例，6—12个月者9例，失访2例。新生血管性青光眼患者虹膜及房角新生血管术后2周内完全消退；眼压降到35mmHg以下者为100％，21mmHg以下者为86．4％；7例术后发现脉络膜脱离。结论 脉络膜上腔引流术治疗难治性青光眼是一种有效可行的方法。     

邯郸地区原发性闭角型青光眼手术患者的远期随访状况调查

目的了解邯郸地区原发性闭角型青光眼(PACG)患者小梁切除术后的随访状况及影响随访的可能因素。设计回顾性病例系列。研究对象河北省邯郸市眼科医院2002年5月-2005年5月的PACG小梁切除术患者410例。方法采用电话、通信等方式通知患者于2006年5-8月回邯郸眼科医院复诊。复诊时详细询问手术后患者的自然随访情况,包括随访频率、日期、用药依从性等,并进行眼科检查,包括矫正视力、裂隙灯、视野及眼底检查,同时进行青光眼认知情况问卷调查。主要指标随访率及调查问卷情况。结果 410份病例中,126例(47.9%)可电话联系到本人,按约复查56例,根据病历中记录的地址发信,按约6例(15.1%)来院复查。62例复查患者中,男性22例,平均年龄(63.5±9.1)岁;复诊时眼压高于21mm Hg 11例(17.7%);最佳矫正视力<0.3者22例(35.5%);平均视野缺损值(-13.1±10.5)dB。术后1、6个月、1、4年的随访率分别为84.4%、41.1%、21.3%、13.3%。Logistic回归分析显示,影响随访率的主要因素是青光眼认知情况(P<0.05)。结论邯郸地区PACG患者小梁切除术后远期随访率较低,4年随访率仅13%,这与对青光眼的认知较差有关。推测我国有相当数量的滤过术后患者不能坚持长期随访,应引起眼科医生的高度重视。     

人工晶体植人术后的随访观察

作者对300例囊内摘出白内障及虹膜夹型Binkhorst人工晶体植入术后随访观察3年。年龄61-90岁,平均74.3岁。其中257例随访34～40个月(30人死亡,13例失访)。患者视力低于20/40者之病因,最常见的是老年性黄斑变性共14例(5%),其次为黄斑囊状水肿5例(2%),角膜水肿3例(1%),视网膜脱离、静脉阻塞、缺血性视乳头病变各2例,青光眼、黄斑皱褶、干燥性角膜炎各1例。300例中19例曾行另外的手术:10例由于玻璃体膜影响视力,6例行单纯刺开术,其中之一患老年性黄斑变性者视力未及20/40,4例其膜致密,以致需从睫状体平部行前玻璃体部分切割术,该4例中3例视力未及20/40,2例     

超声乳化术对小梁切除术后闭角型青光眼患者眼压的长期影响

目的评价超声乳化术对小梁切除术后闭角型青光眼患者眼压的长期影响。方法研究为系列病例观察性研究。选取已接受小梁切除术具有功能性滤过泡的原发性闭角型青光眼和年龄相关性白内障需行超声乳化术的患者19例,每例随机选择1眼进入研究。记录患者超声乳化术前,术后1、3、6个月,1年、2年的眼压和抗青光眼药物治疗情况。用Kaplan-Meier法计算生存率;比较术前、术后1个月、术后2年超声生物显微镜（UBM）对滤过泡和前房的生物测量值。结果共15例患者完成2年的随访,纳入的患者中2例因死亡、另2例因依从性差而失访。超声乳化术前及术后各随访时间点的眼压为（13.5±2.9）、（12.8±2.9）、（12.9±2.7）、（13.0±3.5）、（13.4±3.6）、（12.7±2.9）mmHg,差异无统计学意义（F=0.443,P=0.817）。超声乳化术后2年滤过泡的累积成功率为100%,绝对成功率为87%。UBM测量结果显示,术后前房深度加深,房角进一步开放的象限数量增加,滤过泡的高度下降,三者与术前比较差异均有统计学意义（Z=-3.411,P=0.001;χ2=8.775,P=0.006;Z=-2.927,P=0.003）,但滤过泡的反射率及滤过道差异无统计学意义,术后1个月和术后2年的形态学变化差异无统计学意义。结论长期随访显示,小梁切除术后的原发性闭角型青光眼患者进行超声乳化术眼压控制良好。     

穿透性角膜移植术后继发性青光眼的影响因素及治疗

目的探讨穿透性角膜移植术(penetrating keratoplasty,PKP)后继发性青光眼的发病因素及防治措施。方法对120例(121眼)PKP患者的临床资料进行回顾性分析,探讨发生继发性青光眼患者其术前原发角膜病变的类型及术后主要临床表现,同时观察根据不同病因给予药物或手术治疗后的效果。结果 121眼中发生继发性青光眼者25眼,总发生率为20.66%;发生率较高的有角膜溃疡、排斥再移植、大泡性角膜病变,而单纯性角膜白斑、圆锥角膜、角膜营养不良或变性的发生率相对较低。术后引起继发性青光眼发生的相关因素早期主要由于黏弹剂滞留,严重眼前段炎症,术后发生虹膜前后粘连;晚期主要原因为角膜内皮失代偿,术后使用糖皮质激素未作定期随访,发生免疫排斥反应等。所有患者经分析病因后给予药物或联合手术治疗眼压均得到有效控制。结论 PKP术后继发性青光眼的发生率与术前角膜病变的类型有相关性,临床准确分析病因、给予对应处理可有效控制眼压。     

Moroz人工角膜植入术后并发青光眼患者的临床分析

目的 探讨Moroz人工角膜植入术后并发青光眼患者的发病原因及相关诊疗措施.方法 回顾性病例系列研究.2000年4月至2011年6月对90例(90眼)患者行Moroz人工角膜植入术,15例(15只眼)术后并发青光眼.12例(12只眼)术前有青光眼病史,3例(3眼)术后继发青光眼.所有患者术后1～3个月定期随访,详细记录每名患者眼压、最佳矫正视力、手术前后相关病史、药物及治疗方案.结果 Moroz人工角膜可以显著提高患者术后最佳矫正视力.15例(15只眼)并发青光眼的患者中有8例(53.3％)术前诊断为碱烧伤.5例(5只眼)术后行睫状体冷凝控制眼压,最佳矫正视力分别从0.8降至0.2,0.25降至光感,0.3降至0.1,0.2降至眼前手动,0.4降至指数.结论 Moroz人工角膜植入术后青光眼发生率较低,术前碱烧伤可能是其高危因素.诊断需综合患者的眼压、视野和眼底检查结果.可考虑全身及局部降眼压进行治疗.     

先天性青光眼患者手术后生活质量的调查

目的调查先天性青光眼术后与视力相关的生活质量,并探讨影响其术后视力的原因及防治措施。方法收集1980年至2004年在我院诊断为先天性青光眼并接受手术治疗的患者84例(153只眼),以信函问卷调查、电话质询及门诊随访的方式追踪了解其术后现在的生活质量及眼压、视力、角膜及杯盘比值等的变化情况。结果视力:0．05以下者96只眼(62．7％),0．06至0．3者28只眼(18．3％),大于0．3者29只眼(19．0％)。角膜直径大于12mm者138只眼,其中角膜变性浑浊、葡萄肿、白斑83只眼。在能看清眼底记录C／D的70只眼中,C／D 大于0．8者60只眼。结论先天性青光眼患者生活质量比正常人低,尤其是双眼发病者。手术不成功、诊断及治疗太晚、术后不能长期随访、长期高眼压是造成原发性先天性青光眼盲目及生活质量低下的根本原因。     

硅油乳化继发青光眼及白内障的手术探究

目的:探讨硅油乳化继发青光眼及白内障的手术方式。方法:选取硅油乳化继发青光眼及白内障患者30例30眼,行硅油取出联合晶状体超声乳化人工晶状体植入及小梁切割术,观察患者术后7d～6mo术眼的视力、眼压,以及术后并发症发生的情况。结果:所有术眼均有不同程度的乳化硅油小滴残留,术后视力上升者18眼(60%),下降者7眼(23.3%),不提高者5眼(16.7%);眼压1wk内正常者25眼(83.3%),高于正常者5眼(16.7%);6mo后眼压正常者28眼(93.3%),高于正常者2眼(6.7%);无角膜失代偿、人工晶状体移位或玻璃体积血发生。结论:硅油取出术联合晶状体超声乳化人工晶状体植入及小梁切割术可有效控制硅油乳化继发青光眼及白内障患者的眼压,并提高视力,是一种治疗硅油乳化继发青光眼及白内障安全、有效的术式之一。     

鼻内镜鼻窦手术后失访原因分析及对策

鼻内镜鼻窦手术治疗慢性鼻窦炎鼻息肉的疗效与术后随访及综合治疗有着密切的关系.收集1999年～2002年我科应用鼻内镜手术治疗但未完成随访6个月的慢性鼻窦炎鼻息肉患者42例,对这些病例的失访原因进行了分析,旨在探讨如何提高鼻内镜术后随访成功率,达到提高术后疗效的目的.     

Long-term outcome of pediatric aphakic glaucoma.

PURPOSE: To determine the long-term outcome in pediatric patients with aphakic glaucoma. METHODS: A retrospective analysis of 130 patients diagnosed with aphakic glaucoma between 1969 and 2004 was performed. A total of 36 patients (55 eyes) were included in this study after excluding those who had cataract extraction after age 10 and those patients with other ocular conditions, systemic syndromes, traumatic cataracts, congenital glaucoma, or inadequate follow-up (less than 1 year). Outcome variables studied included visual acuity, number of medication changes required over the course of the follow-up, maximum number of medications used at a time for more than 6 months to control intraocular pressures, and surgical interventions required. Mean follow-up period was 18.7 years (range, 6.9-35 years). RESULTS: At the time of last follow-up, 54.5% of the patients had visual acuity 20/40 or better, 34.5% had 20/50 to 20/200, and 11% had acuity worse than 20/200. During the course of follow-up, 34% required 1 to 2 medication changes for controlling glaucoma, 33% required 3 to 5 medication changes, and 33% required 6 or more medication changes. Thirty-six percent of the eyes required a maximum of 1 to 2 medications for more than 6 months during the course of follow-up, 33% required 3, and 31% required 4 or more medications for controlling intraocular pressure. Of the 55 eyes, 15 eyes (27%) required surgical intervention. Six of the 15 eyes (40%) required 1 surgery, 8 eyes (53%) required 2 to 3 surgeries, and 1 eye (7%) required 4 to 6 surgeries. CONCLUSION: Patients with glaucoma after pediatric cataract surgery can have a good visual outcome although multiple medications and surgical interventions may be required to control the glaucoma.     

Five-year follow-up of macular hole surgery with peeling of the internal limiting membrane: update of a prospective study

PURPOSE: To report on long-term results of macular hole surgery with peeling of the internal limiting membrane (ILM) in a prospective nonrandomized study. METHODS: Sixty-four consecutive patients with a follow-up of at least 36 months were included. Only idiopathic macular holes were included in the study. All patients had undergone standard pars plana vitrectomy with removal of the ILM and intraocular gas tamponade with a 15% hexafluoroethane (C2F6) gas-air mixture followed by a face-down position for at least 5 days. During each follow-up visit, complete clinical examination including determination of best-corrected visual acuity, Goldmann perimetry, and optical coherence tomography was performed. RESULTS: Fifty-two patients were female and 12 were male, and the patients' mean age was 72 years (range, 53-82 years) at the last visit. We observed stage 2 holes in 5 patients, stage 3 holes in 47, and stage 4 holes in 12. The median postoperative follow-up was 62 months (mean, 56 months; range, 36-75 months). Sixty-two patients (97%) were pseudophakic at the last examination: 3 patients (5%) were already pseudophakic at the time of macular hole surgery; a combined procedure was performed on 9 patients (14%); and 50 patients (78%) underwent cataract surgery later. The median follow-up for patients after cataract extraction was 61 months (mean, 56 months; range, 36-75 months). Anatomical closure was achieved in 61 (95%) of 64 patients as confirmed clinically and by optical coherence tomography. No late reopening of a macular hole or formation of epiretinal membranes was observed after successful hole closure. Best-corrected visual acuity improved in 59 (92%) of 64 patients, remained unchanged in 2, and deteriorated in 3. Best-corrected visual acuity improved from a median of 20/100 preoperatively to a median of 20/32 postoperatively (P < 0.001). There was a median gain of 5 lines (range, -6 to 12). The development of visual acuity did not depend on the duration of symptoms, the number of surgeries, or the stage of the macular hole. CONCLUSIONS: Macular hole surgery with peeling of the ILM is a very safe procedure, even in the long term. It leads to very good and stable functional and anatomical results.     

Long-term surgical outcomes of patients with glaucoma secondary to the iridocorneal endothelial syndrome

PURPOSE: To report the long-term outcomes of patients with iridocorneal endothelial (ICE) syndrome who required surgery for glaucoma. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twenty-six patients with ICE syndrome who underwent surgery for glaucoma at one institution between January 1987 and January 2000. MAIN OUTCOME MEASURES: Intraocular pressure (IOP), visual acuity, number of glaucoma medications, and further surgical interventions were measured. RESULTS: Five eyes had a trabeculectomy with an antifibrotic agent alone, seven eyes had a trabeculectomy with an antifibrotic agent and a subsequent glaucoma drainage implant (GDI), and 14 eyes had a GDI alone. In eyes that underwent a trabeculectomy with an antifibrotic agent, preoperative IOP was reduced from a mean of 38.8 +/- 10.5 mmHg on 2.3 +/- 0.8 glaucoma medications to a mean of 11.8 +/- 4.3 mmHg on 1.2 +/- 1.4 medications at last follow-up after surgery (83.8 +/- 40.3 months). In eyes that underwent GDI surgery, preoperative IOP was reduced from a mean of 35.2 +/- 13.0 mmHg on 2.0 +/- 1.3 glaucoma medications to a mean of 8.7 +/- 11.2 mmHg on 1.2 +/- 1.1 medications at last follow-up after surgery (50.5 +/- 40.7 months). Twenty-four eyes (92%) had an IOP less than 22 mmHg, and 22 eyes (85%) had visual acuity 20/400 or better at last follow-up (55.8 +/- 41.5 months). Mean number of glaucoma surgeries per patient over the follow-up period was 1.6 +/- 1.2. Trabeculectomy with antifibrotic agents had a survival of 73% at 1 year, 44% at 3 years, and 29% at 5 years. Glaucoma drainage implants had a survival of 71% at 1 year, 71% at 3 years, and 53% at 5 years. CONCLUSIONS: Glaucoma associated with ICE syndrome can be managed successfully surgically, although multiple procedures are often needed.     

Implantation of Kelman-style, open-loop anterior chamber lenses during keratoplasty for aphakic and pseudophakic bullous keratopathy. A comparison with iris-sutured posterior chamber lenses

The clinical and specular microscopic results of 40 cases (39 patients) of penetrating keratoplasty during which a Kelman-style anterior chamber intraocular lens was implanted were reviewed retrospectively. Thirty-one pseudophakic eyes received an intraocular lens exchange and nine aphakic eyes received a secondary intraocular lens. Postoperative follow-up averaged 24.5 months (range, 3 to 51 months). At 1, 2, and 3 years after keratoplasty, 39.3%, 63.2%, and 63.6% of eyes, respectively, had visual acuities of 20/40 or better. Ninety-five percent of the grafts remained clear. Causes of poor postoperative visual acuity included cystoid macular edema (32.5%), new glaucoma (22.5%), and age-related macular degeneration (10.0%). Other causes were endothelial rejection leading to graft failure, corneal ulceration, and retinal detachment. Corneal endothelial cell loss by specular microscopy was 11.5% at 1 years, 21.3% at 2 years, and 25.0% at 3 years. These results were compared with cell loss associated with iris-sutured posterior chamber lenses in penetrating keratoplasty. Visual outcomes and complication rates were similar between these two methods; however, the endothelial attrition at 1 and 2 years for the sutured posterior chamber lens was greater than that of the Kelman anterior chamber lens.     

Long-term anatomic and visual acuity outcomes after initial anatomic success with macular hole surgery

PURPOSE: To investigate the anatomic and visual outcomes in patients with initial anatomic success after macular hole surgery and with at least 5 years of follow-up. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: Medical records of all patients who underwent surgery for idiopathic full-thickness macular holes by two surgeons (W.E.S., H.W.F.) at the Bascom Palmer Eye Institute between January 1, 1991, and December 31, 1996, were reviewed. All patients who had initial anatomic success with macular hole surgery and who had 5 years or more of follow-up postoperatively were included in the study. Main outcome measures included the rate of macular hole reopening and visual acuity outcomes. RESULTS: Seventy-four eyes of 66 patients with a median age of 68.0 years (range, 45.0-86.8 years) were identified. The median duration of macular hole was 6.0 months (range, 1.1-93.8 months), and the median duration of follow-up after macular hole surgery was 91.0 months (range, 60.0 to 114.8 months). The hole reopened in 9 eyes (12%) during the follow-up interval; 6 of these eyes underwent reoperation, and the hole closed in 4 of 6 (67%). Preoperative visual acuity ranged from 20/50 to 20/400 (mean, 20/129; median, 20/100). In the 62 eyes that underwent cataract extraction (CE) after macular hole surgery, CE was performed at a median of 13.9 months after macular hole surgery. Patients achieved their best postoperative visual acuity at a median of 28.5 months after macular hole surgery. Best postoperative visual acuity ranged from 20/20 to 20/400 (mean, 20/36; median, 20/30). Visual acuity at last follow-up ranged from 20/25 to counting fingers (mean, 20/56; median, 20/40). At last follow-up, 43 eyes (58%) had a visual acuity of 20/40 or better, and 57 (77%) had an improvement in visual acuity of 3 or more Snellen lines compared with their preoperative acuity. CONCLUSIONS: Macular hole closure and visual acuity improvement after initially successful macular hole surgery persist at follow-up of 5 years and longer in the majority of patients; delayed visual acuity improvement is not attributable to cataract surgery alone.     

残联免费白内障手术2 000例中远期疗效观察

目的：观察由残联组织在我院施行白内障免费手术后患者中远期视功能情况。方法：回顾分析2005-08/2011-06在我院施行白内障手术后患者2000例2278眼。随访3mo～3a,记录视力、后发性白内障、眼底情况。结果：术后最后一次随访时：矫正视力≥0.05者2257眼（脱盲率99.08%）;≥0.3者2098眼（脱残率92.10%）。在随访中共发现视力下降392眼,其中后发性白内障278眼,眼底病变107眼,术后迟发性葡萄膜炎5眼,眼外伤2眼。结论：白内障手术后角膜散光、后发性白内障及眼底病变是引起患者视功能损害的主要原因。术后迟发性葡萄膜炎值得重视。在贫困落后地区,眼科医务工作者也应重视向糖尿病和高血压患者宣传其所患疾病的防治知识。     

Deep sclerectomy with SkGel implant: 5-year results

PURPOSE: To evaluate the results of deep sclerectomy with SkGel at 3 and 5 years. MATERIALS AND METHODS: This retrospective trial comprised 200 eyes with open angle glaucoma having a 3-year follow-up, 97 having a 5-year follow-up. Visual acuity, intraocular pressure (IOP), and slit-lamp examination were recorded at baseline and at follow-up visits. Visual field (VF) testing was repeated every 6 months. RESULTS: Mean IOP decreased from 21.01+/-5.56 mm Hg before surgery to 13.13+/-2.24 mm Hg at 36 months and from 20.61+/-5.50 to 12.85+/-1.84 mm Hg at 60 months (P<0.0005). At 3 and 5 years, complete success rates (IOP16 mm Hg) 11% and 10.31%, respectively. VF testing revealed stable mean deviation and corrected pattern standard deviation values at 3 and 5 years (P>0.05). At 3 years, success rate was greater if goniopuncture was performed within 3 months after surgery (P=0.022). Complications of the surgery were not observed after goniopunctures. CONCLUSIONS: Deep sclerectomy with SkGel provides stable control of IOP and VF.     

玻璃体切割术治疗人工晶状体眼视网膜脱离的结果分析

目的探寻人工晶状体眼裂孔性视网膜脱离(pseu-dophakicretinaldetachment,PRD)玻璃体切割术后视网膜再脱离和视力差的原因。方法106例PRD患者均选择玻璃体切割作为首选手术,其中术前27例未发现裂孔,26例曾行Nd:YAG激光后囊膜切开术。术后随访6~94.8月,平均20.8月。结果术后视网膜首次复位77例,29例视网膜再脱离的原因主要是视网膜新裂孔出现和增生性玻璃体视网膜病变。术后视力>0.3者63例,≤0.3者43例。视力≤0.3的主要原因是术后黄斑功能异常(13例)、黄斑前膜(8例)、黄斑水肿(3例)和视神经萎缩(3例)。结论PRD玻璃体切割术后视网膜再脱离的原因主要是新裂孔出现和增生性玻璃体视网膜病变,而视力差的主要原因是术后黄斑功能异常、黄斑前膜、黄斑水肿和视神经萎缩。     

严重眼外伤患者眼内硅油长期存留18例

目的 探讨严重眼外伤患者玻璃体视网膜手术后硅油在眼内长期存留的可行性。设计 回顾性病例系列。研究对象2005-2010年北京同仁眼科中心眼外伤科眼内硅油存留至少2年者18例18眼。方法 患者均行标准20G经睫状体平坦部玻璃体视网膜联合手术,填充普通硅油。术后每3个月随访1次视力、眼压、裂隙灯显微镜及眼底等。主要指标 硅油眼眼部表现。结果 18例均为男性,平均年龄（37.83±14.92）岁,复杂眼外伤17例,急性视网膜坏死1例。硅油眼内存留2～14年,平均（6.41±3.97）年。随访期内3例严重硅油乳化而取出,15例未取出硅油。保留硅油的原因为保留眼球8例（53.33%）、独眼者3例（20.00%）、二次玻璃体手术2例（13.33%）及术后低眼压2例（13.33%）。术后矫正视力无光感～0.2。视网膜复位15例（83.33%）。硅油长期存留的并发症包括继发性青光眼（33.33%）、角膜变性（27.78%）和硅油乳化（22.22%）。结论 对于复杂眼外伤、独眼者、多次手术、低眼压、术后视网膜未复位或有明显增生者,在随访观察无严重并发症时可使硅油眼内长期存留以保持患者眼球外观和视功能。（眼科,2013, 22：58-61）     

Penetrating keratoplasty in Nepal

PURPOSE: To identify indications and outcomes in a large series of penetrating keratoplasty surgeries performed in Nepal. METHODS: A retrospective case series of 472 consecutive penetrating keratoplasty surgeries (408 patients) performed at Tilganga Eye Center, Kathmandu, Nepal from June 1994 to September 1999. RESULTS: Mean recipient age was 39.2 years (+/- 19.7 years). Main indications for PKP were corneal scar (37%), adherent leukoma (35%), perforation or impending perforation (9%), pseudophakic bullous keratopathy (6%), keratoconus (4%), and aphakic bullous keratopathy (3%). Mean duration of follow-up was 27.6 +/- 25.1 months. Sixty-five percent of available grafts were clear at 6 months, and 70% of available grafts were clear at 3 years. Six months postoperatively, 15% of patients had acuity better than 6/18, 37% had acuity between 6/18 and 6/60, and 17.7% had acuity between 6/60 and 3/60. Common causes of graft failure were endothelial failure (43%), increased intraocular pressure (15%), ulcer (14%), and trauma (7%). CONCLUSIONS: The corneal diseases and indications for transplant surgery in Nepal are different from those in the Western world. Despite these differences, penetrating keratoplasty is a successful and reasonable way to reduce corneal blindness in developing nations.