微型角膜刀辅助的板层角膜移植术治疗光治疗性角膜切削术后复发性颗粒状角膜营养不良

目的探讨微型角膜刀辅助的板层角膜移植术治疗光治疗性角膜切削术后复发性颗粒状角膜营养不良的疗效及安全性。方法选择光治疗性角膜切削术后复发性颗粒状角膜营养不良患者7人(9只眼)。用微型角膜刀分别在供体及受体上制作一定厚度的角膜植片及植床,把供体植片对位覆盖于受体植床上,间断缝合4~8针,术后4~6周拆除缝线。术前及术后的不同时间检查视力、角膜透明度、角膜厚度及角膜地形图。结果在平均(18.9±4.1)个月的随访期内,所有植片没有明显的混浊及严重并发症。患者术后视力均有不同程度的提高,其中7只眼最佳矫正视力大于或等于0.5,2只眼视力达到0.8,12个月后,角膜的屈光力平均增加(2.34±0.93)D(P<0.01),散光平均减小(0.91±0.98)D(P<0.05),术前角膜平均厚度(477.4±26.9)μm,至随访结束时角膜的平均厚度为(507.8±23.4)μm(P<0.01)。结论微型角膜刀辅助的板层角膜移植术治疗光治疗性角膜切削术后复发性颗粒状角膜营养不良是安全、有效的治疗方法。(中华眼科杂志,2005,41:1000-1004)

Microkeratome-assisted lamellar keratoplasty for recurrent corneal granular dystrophy after phototherapeutic keratectomy

OBJECTIVE: To evaluate the safety and efficacy of mircokeratome-assisted lamellar keratoplasty (MLK) for the treatment of recurrent granular corneal dystrophy (GCD) after phototherapeutic keratectomy (PTK). METHODS: We performed a prospective study of nine eyes (seven patients) with recurrent granular dystrophy after PTK. A microkeratome was used to cut partial-thickness sections through the anterior surface of the donor and host corneas. The donor disc was placed on the recipient bed with four or eight interrupted sutures. The stitches were removed between 4 and 6 weeks after surgery. Visual acuity (VA), corneal clarity, corneal thickness, and corneal topography were assessed before and at different time points after surgery. RESULTS: During a mean follow-up period of (18.9 +/- 4.1) months, all grafts were transparent without visible opacity at the interface, and no serious complications occurred. The VA was improved in all cases. seven eyes had best corrected visual acuity with spectacles of 20/40 or better, two eyes reached 20/25. At the last follow-up visit more than 12 months postoperatively, the mean corneal refractive power increased significantly by (2.34 +/- 0.93) D (P < 0.01), and the corneal astigmatism significantly decreased by (0.91 +/- 0.98) D (P < 0.05). The mean corneal thickness was (477.4 +/- 26.9) microm preoperatively and (507.8 +/- 23.4) microm at the last follow-up visit (P < 0.01). CONCLUSIONS: Our findings suggest that MLK for the treatment of recurrent GCD is a safe and easy-to-perform method for restoring VA.