Bowman layer transplantation: 5-year results
Bowman layer transplantation: 5-year results
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DOI：
10.1007/s00417-018-3927-7
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发表时间：
2018-06-01
影响因子：
2.7
通讯作者：
Melles, Gerrit R. J.
中科院分区：
文献类型：
--
作者：
van Dijk, Korine;Parker, Jack S.;Melles, Gerrit R. J.
目的 本研究的目的是评估离体鲍曼层 (BL) 移植治疗晚期圆锥角膜的 5 年临床结果。 方法 在三级转诊中心的前瞻性、单中心介入病例系列中，17 名晚期圆锥角膜患者的 20 只眼睛接受了 BL 移植，即将离体鲍曼层移植物置于手动解剖的中基质袋中。基于 Scheimpflug 的角膜断层扫描测量、最佳矫正眼镜和隐形眼镜视力（BSCVA 和 BCLVA）、内皮细胞密度和并发症在术后 5 年内进行评估。结果 测量的模拟角膜曲率和最大角膜曲率（Kmean 和 Kmax）值在术后 5 年内保持稳定（与 1 个月随访相比，5 年的 P = .310 和 P = .195 分别），从术前到术后 1 个月最初下降（各 P < .001）。平均 LogMAR BSCVA 保持稳定 (P > .99)，从术前到术后 12 个月有初步改善 (P = .007)。平均 BCLVA 从术前到术后 5 年没有变化 (P = .219)。在所有术后随访期间，平均光密度值均高于术前 (P < .001)。术后4.5年，一只眼出现角膜积水；未观察到其他术后并发症。 Kaplan-Meier 分析显示术后 5 年估计成功率为 84%。从手术前到术后 5 年，内皮细胞密度保持稳定 (P = .319)。 结论 术后早期角膜变平后，BL 移植后长达 5 年的拓扑结构保持稳定，保留了 BCLVA 和隐形眼镜耐受性，可能允许长期推迟穿透性或深前板层角膜移植术。
Purpose The purpose of this study was to evaluate the 5-year clinical results of isolated Bowman layer (BL) transplantation in the treatment of advanced keratoconus.Methods In this prospective, single-center, interventional case series at a tertiary referral center, 20 eyes of 17 patients with advanced keratoconus underwent BL transplantation, i.e. an isolated Bowman layer graft was positioned into a manually dissected mid-stromal pocket. Scheimpflug-based corneal tomography measurements, best corrected spectacle and contact lens visual acuities (BSCVA and BCLVA), endothelial cell density, and complications were evaluated up to 5 years after surgery.Results Measured simulated and maximum keratometry (Kmean and Kmax) values were stable up to 5 years after surgery (P = .310 and P = .195 for 5 years compared to 1 month follow-up, respectively), following an initial decrease from pre-to 1 month postoperatively (P < .001 each). Mean LogMAR BSCVA remained stable (P >.99), after an initial improvement from pre-to 12 months postoperatively (P = .007). Mean BCLVA did not change from preoperative to 5 years postoperatively (P = .219). During all postoperative follow-ups, mean densitometry values were higher than preoperatively (P < .001). A corneal hydrops occurred in one eye at 4.5 years postoperatively; no other postoperative complications were observed. Kaplan-Meier analysis showed an estimated success rate of 84% at 5 years postoperatively. Endothelial cell density remained stable from before to 5 years after surgery (P = .319).Conclusions After early postoperative corneal flattening, topographies were stable up to 5 years after BL transplantation, preserving BCLVA and contact lens tolerance, potentially allowing long term postponement of penetrating or deep anterior lamellar keratoplasty.