METHODS: In this prospective interventional case series, 5 patients with advanced progressive KC underwent BL onlay grafting. After removal of the epithelium, a BL graft was placed and \"stretched\" onto the stroma, and a bandage lens was placed to cover the BL graft. In 1 case, BL onlay grafting could be performed immediately after ultraviolet corneal crosslinking; all other eyes were ineligible for ultraviolet corneal crosslinking. Best spectacle- and/or best contact lens-corrected visual acuity, refraction, biomicroscopy, corneal tomography, anterior segment optical coherence tomography, and complications were recorded at 1 week and at 1, 3, 6, 9, and 12 to 15 months postoperatively.
RESULTS: All 5 surgeries could be performed successfully. Average maximum keratometry went from 75 diopters (D) preoperatively to 70 D at 1 year postoperatively. All eyes showed a completely reepithelialized and a well-integrated graft. Best spectacle-corrected visual acuity improved at least 2 Snellen lines (or more) in 3 of 5 cases and best contact lens-corrected visual acuity remained stable, improving by 3 Snellen lines in case 1 at 15 months postoperatively. Satisfaction was high, and all eyes again had full contact lens tolerance.
CONCLUSIONS: BL onlay grafting may be a feasible surgical technique, providing up to -5 D of corneal flattening in eyes with advanced KC.
方法:在这个前瞻性介入病例系列中,5例晚期进行性KC患者行BL嵌体移植术。去除上皮后,放置BL移植物并“拉伸”到基质上,并放置绷带透镜以覆盖BL移植物。在1种情况下,可以在紫外线角膜交联后立即进行BL嵌体移植;所有其他眼睛都不适合进行紫外线角膜交联。最佳眼镜和/或最佳隐形眼镜矫正视力,折射,生物显微镜,角膜断层扫描,眼前节光学相干断层扫描,并记录术后1周和术后1,3,6,9和12~15个月的并发症.
结果:所有5例手术均可成功进行。平均最大角膜屈光度从术前的75屈光度(D)增加到术后1年的70D。所有的眼睛都显示出完全的上皮化和完整的移植物。在5例中的3例中,最佳眼镜矫正视力至少改善了2条Snellen线(或更多),最佳隐形眼镜矫正视力保持稳定,病例1在术后15个月改善了3条Snellen线。满意度很高,所有的眼睛都有完全的隐形眼镜耐受性。
结论:BL嵌体移植可能是一种可行的手术技术,在具有高级KC的眼睛中提供高达-5D的角膜展平。