Clinical Analysis Of Total Lamellar Cornea With Circular Lamellar Sclera Transplantation For Treating Serious Ocular Surface Disorders

objective: To investigate effects of total lamellar cornea with circular lamellar sclera transplantation (CST) for treating serious ocular surface disordersMethod : 23 eyes of 23 patients(from Feb. 1996 to Feb. 2006) suffered from serious ocular surface disorders. They were treated with CST. We observed and analyzed the postoperative status of corneal grafts, neovascularizations, rejections and visual acuities,during 6-24 months,followed-up.Result: Visions in 19eyes (82.6%)were improved in different degrees and there were no changes in 4 eyes (17.4%). 13 eyes, corneal grafts were transparent(56.5%), 9 eyes Semiytansparent and 1 eyes, opacity. Rejections were happened in 9 eyes(39.1%), neovascularization in 8 eyes(34.8%) ,corneal epithelium defect 5 eyes(21.7%), secondary glaucoma in 3 eyes(13.0%), hematocle between lamellar cornea 2 eyes,"double anterior chamber"2 eyes, and infection in one eye.Conclusions:1. Limbal Stem Cells are responsible for corneal epithelium cellular proliferation, differentiation and migrate . Limbal stem cells deficiency show neovascularization, chronic Inflammatory reaction and corneal opacity . Recovery of Limbal Stem Cells and reconstitution of ocular surface should be focused to treat serious ocular surface disorders .CST can be used to treat serious ocular surface disorders with limbal stem cells defect or functional disturbance. 2. To perform CST , materials of donator should be fresh and time of conservation shouldn't be too long , in order to avoid effecting activity of limbal stem cells for edema of corneal epithelium . To ascertain the depth of excision by Preoperative examination with slitlamp microscope, in order to resect blood vessel of deep layer thoroughly and avoid perforation of receptor .When CST is used to treat serious ocular chemical burns, The improvement of these eyes conditions plays an important role in corneal transplantion. 3 . Postoperative complications should be found and treated early to improve achievement ratio of the transplantation.①The immunologic rejection is still a main factor to the failure of the operation and need to be prevented and cured actively. excision of pathological tissue and new vessels thoroughly in the operation and long use of immunosuppressive agent are key points of successful operation. systemic steroids and other immunosuppressive drugs such as cyclosporin and tacrolimus (FK506) are of proven benefit, both for treatment and prevention of rejection.②neovascularization is a pathological phenomenon related to corneal burn ,corneal inflammation and corneal rejection .For neovascularization, the glucocorticoid and CsA are mainly medicine. We should dismantle the loose suture in time.③corneal epithelium defect: epithelium integrity of implant after corneal transplantation is very important to healing of corneal wound and reconstitution of postoperative vision,and it is is very important to use the medicine that promote corneal epithelium to grow to keep epithelium integrity of implant after corneal transplantation④secondary glaucoma: . According to the degree of IOP we should adopt different operative or pharmacal way.⑤infection:infection is a very serious complication. It is very important to sterilize the donator, and examine operative eye carefully. Infected eyes should be performed corneal transplantation after treatment and be awared the sign of infection after operation. We should dismantle the loose suture in time. besides,it is strictly sterile to take out stitches and use antibiotic to prevent infection .