穿透性角膜移植术后的散光矫治

Management of postpenetrating keratoplasty astigmatism

穿透性角膜移植术可以使角膜盲患者复明或者控制角膜病变进展.成功的角膜移植不仅需要植片透明,还要获得较好的视力.目前穿透性角膜移植术后残留的高度散光成为影响术后视力恢复的原因之一,也一直是屈光角膜医生面临的难题.对其矫治主要包括两个阶段：第一阶段,缝线处理,通过调整角膜缝线张力和选择性拆除角膜缝线改变角膜曲率,达到矫正散光的目的;第二阶段,缝线完全拆除后残余的散光,可以通过光学镜片或手术来矫治.光学矫治主要包括框架眼镜和角膜接触镜,其中近年来硬性透气性角膜接触镜和巩膜镜使用较多.手术方法除了传统的通过改变角膜曲率来实现散光矫治的角膜松解切开术及角膜楔形切除术外,还包括激光角膜屈光手术、角膜基质环植入术及人工晶状体植入术等新型矫治方法.近年来,飞秒激光辅助的角膜松解切开术、角膜楔形切除术及角膜基质环植入术等,使散光的矫治更加精准,术后并发症减少.

Penetrating keratoplasty （PKP） can restore vision or control the development of corneal disease.A successful corneal graft requires both clarity and an acceptable refraction.After PKP,astigmatism remains a challenge for corneal refractive surgeons,it is a limiting factor in the visual rehabilitation of otherwise successful corneal grafts.The management of postkeratoplasty astigmatism include two stages：in the first stage,it managed by suture manipulation：suture removal along the steep meridian of astigmatism and suture adjustment,which can change the corneal curvature,and decrease the corneal astigmatism.If significant astigmatism remains after suture removal,it can be corrected by optical means or surgical procedures.The optical means include spectacles and contact lenses.The doctors usually use rigid gas-permeable contact lenses and scleral contact lenses.The surgical procedures include traditional incisional keratotomy,wedge resection and modern intrastromal corneal ring segments,laser refractive surgery,intraocular lens implantation and so on.Femtosecond laser （FSL） technology has been recently introduced in the clinical practice,it can increase the safety and efficacy,otherwise it also can decrease the complication.