Аctualization autosclerokeratoplasty in corneal diseases

Laptev N.E., Lapteva A.V.

Rationale: Diseases of the cornea of the eye account for a quarter of the total incidence of ophthalmological pathologies, which, in turn, are detected in 11% of all cases of appeals. These pathologies are dangerous, since 75% of patients with this group of diseases may subsequently develop visual impairment, up to its complete loss. In case of severe lesions, surgical intervention is inevitable, while both allo- and autografts can be used for corneal flap transplantation, with the sclera being the most preferred option in this case. Autosclerokeratoplasty seems to be a modern, most rational method for treating severe pathologies of the cornea, and updating this method seems to be a very important task.

Objective: updating the method of autosclerokeratoplasty for corneal lesions using a clinical example of the successful use of the method for ulcerative lesions of the cornea.

Methods: An analytical work of scientific literature for the last 10 years was carried out, PubMed databases were used, including PubMed Central, Google Scholar, CyberLeninka. The search was conducted using the keywords “autosclerokeratoplasty”, “autosclera”, “corneal ulcer”, etc.

To characterize the possibility of using autosclerokeratoplasty in clinical practice for corneal damage, a clinical case is given, medical documentation was used for the analysis: outpatient card, medical history, instrumental and physical examination data. The data were systematized using modern methods of information analysis.

Results: The method has many advantages over other methods of surgical treatment of corneal pathologies: 1) performing anterior lamellar keratoplasty of the cornea allows to reliably close the optical zone, eliminating the threat of perforation and in some cases improve the patient’s vision, 2) in case of a threat of rejection of the lamellar keratograft, it is possible to take a second peripheral fragment of the cornea under the upper eyelid, 3) suture fixation of the autoscleral flap over the area ofthe corneal defect under the upper eyelid allows to achieve an aseptic course of the process, 4) the location of the area for taking the lamellar keratograft under the upper eyelid does not worsen the cosmetic appearance of the operated eye. Based on a clinical case with a severe patient, the potential of this operation is visible.

Conclusion: autosclerokeratoplasty is a progressive method of surgical treatment of corneal pathologies. Since the incidence of these pathologies is high, and the risk of disability is high, the actualization of this method is most important. At the same time, all the current data on the possibilities of autosclerokeratoplasty are provided based on scientific literature and a clinical case.

1. Reinhard, Thomas; Sundmacher, Rainer. Lamelläre Horse-Shoe Sklerokeratoplastik und Thermoplastik bei Keratokonus mit peripherer Keratektasie. Klinische Monatsblätter für Augenheilkunde. 1994; 205(11): 305 – 308. DOI: 10.1055/s-2008-1045534

2. Patent № 2692617 RF, A61F 9/007. Sposob monolateral’noi autokeratoplastiki opticheskoi zony rogovoi obolochki: 2018121697: zayavl. 2018.06.13: opubl. 2019.06.25 / Tsvetkov A.L., Tsvetkov A.A. (In Russ.)

3. Patent № 2692600 RF, A61F 9/007. Sposob plastiki perforatsii rogovoi obolochki loskutom autosklery: 2018121586: zayavl. 2018.06.13: opubl. 2019.06.25 / Tsvetkov A.L., Tsvetkov A.A. (In Russ.)