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KMID : 0381219750070020091
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Journal of RIMSK
1975 Volume.7 No. 2 p.91 ~ p.107
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Advances in Keratoplasty
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Abstract
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The essence of keratoplasty is the maintenance of the vitality and clarity of the graft. About 60 years ago, Dr. Elschnig performed the first successful and well-documented partial auto-and allografts of human cornea with von Hippel´s original trephine.
In uncomplicated cases, it is now possible to obtain an improvement of clear grafts and good vision in 90-100%.
This accomplishment for a corneal transplant to be successful has been made possible, (1) by a more precise understanding of the basic knowledges about the vitality of the fragile endothelial monolayer cells which must be preserved and protected from the slight trauma, dryness, oxygen deprivation, pH change, and other physico-chemical conditions, (2) by the development of microsurgical instruments with availability of refine sutures and needles under the use of operating microscope, (3) by the improvement of methods in preserving donor materials, (4) by the information about the corneal graft failures and improved treatments, and (5) by a better knowledge of the corneal biology, far more careful selection of donor tissue was been accomplished.
In aphakic eyes or in simulteneous keratoplasty and cataract extraction, vitreous body must be kept away from the endothelial surface and wound edges to prevent its touch and so the vitrectomy is usually essential.
And after grafting, the endothelium can survice relativelly for prolonged periods of time and this made a possibilty of keratoplasty for advanced Fuchs´ dystrophy and bullous keratopathy.
Cryopreserved donor cornea (one year or more under -196°C) can be used successfully for penetrating keratoplasty which its endothelium is the most crucial tissue in this time. Dead corneal tissue whose architecture is preserved in glycerol, or by other means can be only successful in lammellar keratoplasty.
It has recently been reported about the alkali-burned cornea to be successful that the donor corneal epithelium which is the most crucial tissue in this time must survive and must be protected from external damage by using of epikeratoprosthesis or soft contact lens.
Graft rejection is also estimated as 10116 or less in good prognosis cases, yet as high as 3040% in other type of poor cases. And three layers of ´the cornea could reject separately or simultaneously. Cell-mediated immunity reaction are clearly responsible for the main phenomena of corneal graft rejection, but the possible contribution of humoral responses remain uncertain.
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