Deep lamellar endothelial keratoplasty - Visual acuity, astigmatism, in a large prospective series
Deep lamellar endothelial keratoplasty - Visual acuity, astigmatism, in a large prospective series
复制标题
DOI：
10.1016/j.ophtha.2005.03.026
复制
发表时间：
2005-09-01
期刊：
影响因子：
13.7
通讯作者：
Ousley, PJ
中科院分区：
文献类型：
--
作者：
Terry, MA;Ousley, PJ
目的：报告6个月的结果为治疗角膜上皮功能障碍的一个大的，前瞻性系列的深板层角膜上皮移植术（DLEK）proceedings.Design：前瞻性，noncomparative，介入性cases series.Participants：100眼88例患者角膜水肿Fuchs营养不良和pseudophakia.Methods：角膜缘，巩膜，部分深度切口提供了一个深板层角膜囊袋剥离。由于解剖不佳，在DLEK手术时，2只眼转为穿透性角膜移植术（PK）。在完成DLEK手术的98只眼中，36只眼接受大切口技术（9 mm巩膜入路切口），62只眼接受小切口技术（5 mm巩膜入路切口）。然后切除7.5- 8.0-mm的受体组织后板层椎间盘，并通过囊袋用含有健康内皮的类似尺寸的供体椎间盘替换。一个临时的空气泡在前房用于供体组织粘附，没有表面角膜切口或缝线是necessary.Main结果测量：术前和术后最佳矫正视力（BSCVA），明显的屈光（MR）散光，和角膜上皮细胞密度（ECD）进行了前瞻性评价。结果：术后6个月，98只DLEK角膜均透明，植片位置良好。平均BSCVA为20/46，范围在20/20和20/400之间。平均MR散光为1.34 +/- 0.86屈光度（D），表示散光较术前的平均变化为+0.28 +/- 1.08 D（P = 0.013）。术后6个月的平均ECD为2140 +/- 427 cells/mm（2），术前供体细胞测量的平均细胞丢失率为25%。结论：DLEK手术无需角膜表面切口和缝合，保留了正常的角膜地形图，最大限度地减少了散光，并提供了健康的供体角膜上皮细胞计数和功能。DLEK手术代表了PK的合理替代方案，与历史PK数据相比，在治疗角膜上皮功能障碍方面提供了上级屈光结局。
Purpose: To report the 6-month results for the treatment of enclothelial dysfunction in a large, prospective series of deep lamellar enclothelial keratoplasty (DLEK) procedures.Design: Prospective, noncomparative, interventional case series.Participants: One hundred eyes of 88 patients with corneal edema from Fuchs' dystrophy and pseudophakia.Methods: A limbal, scleral, partial-depth incision provided access for a deep lamellar corneal pocket dissection. Two eyes were converted to penetrating keratoplasty (PK) at the time of DLEK surgery because of poor dissections. Of the 98 eyes that had completed DLEK surgeries, 36 eyes received a large-incision technique (9-mm scleral access incision) and 62 eyes received a small-incision technique (5-mm scleral access incision). A 7.5- to 8.0-mm posterior lamellar disc of recipient tissue then was excised and replaced through the pocket with a similar size donor disc containing healthy endothelium. A temporary air bubble in the anterior chamber was used for donor tissue adherence, and no surface corneal incisions or sutures were necessary.Main Outcome Measures: Preoperative and postoperative best spectacle-corrected visual acuity (BSCVA), manifest refraction (MR) astigmatism, and enclothelial cell density (ECD) were evaluated prospectively. Results: At 6 months after surgery, all 98 DLEK corneas were clear and the grafts were healed in good position. The mean BSCVA was 20/46, with a range between 20/20 and 20/400. The average MR astigmatism was 1.34 +/- 0.86 diopters (D), representing an average change in astigmatism from before surgery of +0.28 +/- 1.08 D (P = 0.013). The average ECD at 6 months was 2140 +/- 427 cells/mm(2), representing a mean cell loss from preoperative donor cell measurements of 25%.Conclusions: The DLEK procedure, with its absence of corneal surface incisions and sutures, preserves the normal corneal topography, minimizes astigmatism, and provides a healthy donor enclothelial cell count and function. The DLEK procedure represents a reasonable alternative to PK, and compared with historical PK data, offers superior refractive outcomes in the treatment of enclothelial dysfunction.