| 摘要: |
| 角膜移植三联手术包括角膜移植、白内障摘除及人工晶体(intraocular lens, IOL)植入术。其中角膜移植的手术方式可大体分为穿透性（penetrating keratoplasty, PKP）、前板层及后板层移植，白内障摘除的方式可为晶体囊外摘除、超声乳化吸除及小切口手法摘除，IOL植入的时机可与角膜移植同步实施或待植床和全眼屈光参数稳定后二期植入。植入IOL的方式为后房囊袋内、睫状沟处、巩膜壁缝线悬吊或巩膜层间晶体襻植入。为了减少PKP术中玻璃体腔正向压力（positive vitreous pressure, PVP）的风险，建议采用全身麻醉或玻璃体核心部微创切割减压。重视远视漂移问题后，后弹力层角膜内皮移植术（Descemet’s membrane endothelial keratoplasty，DMEK）三联术中的IOL度数可较为准确地被术前测量。波士顿人工角膜三联手术可较有效地使严重眼表角膜病变者增视。 |
| 关键词: 穿透性角膜移植术 板层角膜移植术 角膜内皮移植术 人工晶体植入术 白内障 |
| DOI：10.16118/j.1008-0392.2019.04.002 |
| 通信作者: |
| 投稿时间：2019-04-12 |
| 录用日期： |
| 基金项目:国家自然科学基金（30973247，81470028）；教育部新世纪优秀人才支持计划（NCET-13-0420）；上海市卫生系统优秀学科带头人培养计划（2017BR060） |
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| The triple procedure of cataract extraction, intraocular lens implantation and corneal graft: current status and related issuesBI Yan-long |
| BI Yan-long |
| ((Dept. of Ophthalmology, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China)) |
| Abstract: |
| Keratoplasty triple surgery include corneal graft, cataract extraction and intraocular lens implantation. Surgical methods of keratoplasty include penetrating keratoplasty (PKP), anterior lamellar keratoplasty and posterior lamellar keratoplasty. Surgical methods of cataract surgery include extracapsular cataract extraction, phacoemulsification and manual small incision cataract surgery. Time points of the intraocular lens (IOL) implantation can be simultaneous to keratoplasty or in a second stage. The IOL can be implanted in capsular bag, in the ciliary sulcus or by scleral fixation. In order to decrease the positive vitreous pressure during PKP, general anesthesia or minimally invasive core vitrectomy are advised. Attention should be paid to the phenomenon of hyperopic shift. The Descemet’s membrane endothelial keratoplasty (DEMK) is benefit of predicting an accurate refractive power of IOL during triple procedure. Boston type Ⅰ keratoprosthesis triple technique is helpful for patients with severe ocular surface diseases. |
| Key words: penetrating keratoplasty lamellar keratoplasty corneal endothelial keratoplasty intraocular lens implantation cataract |
