Deep Anterior Lamellar Keratoplasty Using Big-Bubble Technique for Treatment of Corneal Stromal Scars
Deep Anterior Lamellar Keratoplasty Using Big-Bubble Technique for Treatment of Corneal Stromal Scars
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DOI：
10.1097/ico.0b013e3181eeb44a
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发表时间：
2011-06-01
期刊：
影响因子：
2.8
通讯作者：
Yucel, Iclal
中科院分区：
文献类型：
--
作者：
Arslan, Osman Sevki;Unal, Mustafa;Yucel, Iclal
目的：报道深度前板层角膜移植术（DALK）治疗各种病因引起的角膜前基质瘢痕的临床效果。方法：对79例角膜间质瘢痕患者79眼，采用大泡法行角膜间质瘢痕修复术。该研究的主要结果测量是成功完成DALK的能力、术中和术后并发症、最佳眼镜矫正视力、屈光和移植物清晰度。结果：72例手术均按DALK方式进行，平均随访时间28.1±17.9个月（范围12 ~ 78个月）。DALK手术最常见的适应症是疱疹后角膜炎（44%）。57例（79%）患者可通过大泡（descemetic DALK）完成Descemet膜暴露。15只眼（21%）需要逐层手工解剖（造血前DALK）。术后最佳眼镜矫正视力6/12及以上59眼（82%）。平均球面等效屈光度为-3.32 +/- 2.13（范围：-9.13 ~ +4.75），平均地形像散为-2.97 +/- 1.94（范围：-8.0 ~ +4.50）。有2例间质移植排斥反应，对药物治疗有反应。结论：DALK大泡技术是一种有价值且安全的治疗角膜间质瘢痕的方法。视力和屈光结果与标准穿透性角膜移植术相当，避免了内皮排斥反应的风险。
Purpose: To report the clinical outcomes of deep anterior lamellar keratoplasty (DALK) in patients with anterior corneal stromal scars associated with various etiologies.Methods: A total of 79 eyes of 79 patients with corneal stromal scars sparing the Descemet membrane and the endothelium underwent DALK by using big-bubble technique. The main outcome measures of the study were the ability to successfully complete DALK, intraoperative and postoperative complications, best spectacle-corrected visual acuity, refraction, and graft clarity.Results: Seventy-two of the surgical procedures were carried out as DALK, and the mean follow-up time was 28.1 +/- 17.9 months (range, 12-78 months). The most frequent indication for DALK surgery was postherpetic keratitis (44%). Complete Descemet membrane exposure via big bubble (descemetic DALK) could be achieved in 57 cases (79%). Fifteen eyes (21%) required layer-by-layer manual dissection (predescemetic DALK). Best spectacle-corrected visual acuity of 6/12 or better was present in 59 eyes (82%) postoperatively. The mean spherical equivalent and topographic astigmatism were -3.32 +/- 2.13 (range, -9.13 to +4.75) and -2.97 +/- 1.94 (range, -8.0 to +4.50) diopter, respectively. There were 2 instances of stromal graft rejection, which responded to medical therapy.Conclusions: DALK big-bubble technique may be a valuable and safe treatment in patients with corneal stromal scar with healthy endothelium. The visual and refractive outcomes are comparable to standard penetrating keratoplasty, avoiding the risk of endothelial rejection.