Ring-shaped corneoscleral lamellar keratoplasty guided by high-definition optical coherence tomography and Scheimpflug imaging for severe Terrien's marginal corneal degeneration

摘要

Background: To evaluate the clinical efficacy of ring-shaped corneoscleral lamellar keratoplasty under guidance of highdefinition optical coherence tomography (HD-OCT) and Scheimpflug imaging for severe Terrien's marginal corneal degeneration. Methods: Twenty-five patients (25 eyes) with Terrien's marginal corneal degeneration and≥6 diopters of astigmatism were treated at the Shandong Eye Institute from January 2008 through December 2010. In these patients, the diseased area was>1 quarter of the cornea, and the thickness at the thinnest corneal area was<150 μm with residual corneal stroma. Ringshaped corneoscleral lamellar keratoplasty was performed, and the depth and width of dissection was set according to the HDOCT and Pentacam examinations. Data of complications, surgical effects, visual acuity, and astigmatism were collected. Results: No intraoperative corneal perforation occurred. No patients had liquid accumulation between the graft and the recipient. At 1 year after surgery, the average best-corrected visual acuity improved to 6/9 from preoperative 6/36, and the average astigmatism reduced to 4.37 (2.04) diopters from preoperative 13.39 (7.52) diopters. There was no recurrence of the disease or corneal graft rejection in the follow-up period. Conclusions: Ring-shaped corneoscleral lamellar keratoplasty guided by HD-OCT and Pentacam imaging appears to be effective in the treatment of severe Terrien's marginal corneal degeneration. Surgical perforation can be significantly reduced.