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Abstract：
The purpose of this study was to investigate the role of corneal crosslinking (CXL) of grafts during keratoplasty (KP) in patients with refractory corneal melting (CM). This is a retrospective case series reporting the clinical outcomes of patients who received a crosslinked corneal graft during penetrating or deep anterior lamellar KP for refractory infectious or sterile CMs. Outcome measures were the recurrence of CM, the time required for epithelial healing following KP, incidence of complications, and necessity for re-transplantation. Twenty eyes of 18 patients with a follow-up of 29.2 ± 15.8 months were included in this study. All but two eyes had undergone previous KPs during the course of their disease (mean 1.9 ± 1.6). After CXL-enhanced KP, three eyes (15%) experienced recurrence of CM, three eyes developed an infectious keratitis and six eyes (30%) required a re-transplantation (three of them within 12 months). The mean time to epithelium closure after CXL-enhanced KP was 63 ± 90 days. The number of postoperative re-transplantations was significantly lower than the number of KPs performed before the CXL-enhanced transplantation (before CXL 1.9 ± 1.6 vs after CXL: 0.3 ± 0.57, p = 0.002). To conclude, CXL of the graft at the time of keratoplasty decreased the need for re-transplantations. However, further studies are needed in order to establish its role in the management of severe CM necessitating therapeutic corneal transplantation.
摘要：
目的探讨难治性角膜融解(CM)患者角膜移植术(KP)中移植物角膜交联(CXL)的作用。这是一个回顾性病例系列，报告了在穿透性或深前板层KP治疗难治性感染性或无菌性CM期间接受交联角膜移植物的患者的临床结果。KP后上皮愈合所需的时间，并发症的发生率，以及重新移植的必要性。本研究包括18例患者的20只眼，随访时间为29.2±15.8个月。在疾病过程中，除两只眼睛外，所有眼睛都经历了先前的KP（平均1.9±1.6）。在CXL增强的KP之后，三只眼睛（15%）经历了CM复发，三只眼出现感染性角膜炎,六只眼(30%)需要再次移植(其中三只在12个月内).CXL增强的KP后上皮闭合的平均时间为63±90天。术后再次移植的数量显着低于CXL增强移植前进行的KP数量（CXL前1.9±1.6与CXL后：0.3±0.57，p=0.002）。最后，角膜移植术时移植物的CXL减少了重新移植的需要。然而,需要进一步的研究，以确定其在需要治疗性角膜移植的严重CM的管理中的作用。
