Outcomes of Deep Anterior Lamellar Keratoplasty Using the Big-Bubble Technique in Various Corneal Diseases
Outcomes of Deep Anterior Lamellar Keratoplasty Using the Big-Bubble Technique in Various Corneal Diseases
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DOI：
10.1016/j.ajo.2012.02.025
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发表时间：
2012-08-01
影响因子：
4.2
通讯作者：
Gao, Na
中科院分区：
文献类型：
--
作者：
Huang, Ting;Zhang, Xueyan;Gao, Na
目的：报道应用大气泡技术行深前板层角膜移植(DALK)的临床结果。设计：前瞻性干预研究。方法：对115例(131只眼)不同诊断的非选择性连续行DALK的患者进行单医院研究。结果：晚期圆锥角膜25只眼(80.6%)，化学或热烧伤11只眼(73.3%)，角膜营养不良20只眼(71.4%)，单纯疱疹病毒性角膜炎瘢痕21只眼(70%)，中度圆锥角膜4只眼(36.4%)，细菌性角膜炎瘢痕5只眼(31.3%)。术后4~7个月有24只眼(23.8%)出现缝线松动。上皮性排斥反应2眼，间质排斥反应5眼。术后1年，HSK瘢痕形成、角膜营养不良与圆锥角膜、角膜烧伤相比，BSCVA均有改善(P<；0.05)，但平均随访21.4个月后，BSCVA改善不明显(P<；0.05)。发生间质排斥反应的患者在18个月和24个月时的ECD低于无排斥反应的患者(P<；0.05)。在6个月后的所有随访时间，多次注气的患者的ECD均低于1次注气的患者(P<；0.05)。结论：大气泡技术在不同的诊断中观察到不同的Descemet膜暴露率。严重的基质排斥反应和额外的操作都可能对角膜内皮产生有害影响。《眼科杂志》2012；154：282-289。2012(C)由Elsevier Inc.保留所有权利。)
PURPOSE: To report clinical outcomes of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in various original diagnoses.DESIGN: Prospective interventional study.METHODS: Single hospital study of 115 unselected consecutive patients (131 eyes) with various diagnoses undergoing DALK using the big-bubble technique. The main outcome measures were intraoperative and postoperative complications, postoperative best spectacle-corrected visual acuity (BSCVA), and endothelial cell density (ECD).RESULTS: Descemet membrane was exposed successfully in 25 eyes (80.6%) with advanced keratoconus, 11 (73.3%) with chemical or thermal burns, 20 (71.4%) with corneal dystrophy, 21(70%) with a herpes simplex (HSK) keratitis scar, 4 (36.4%) with moderate keratoconus, and 5 (31.3%) with a bacterial keratitis scar (P < .05). Loosening of the sutures occurred in 24 eyes (23.8%) between postoperative4 and 7 months. Epithelial rejection was observed in 2 eyes and stromal rejection occurred in 5 eyes. BSCVA was improved in HSK scarring and corneal dystrophy vs keratoconus and corneal burns at 1 year (P < .05), but not after a mean follow-up of 21.4 months (P < .05). Patients who experienced stromal rejection had lower ECD than patients with no rejection at 18 and 24 months (P < .05). At all follow-up times after 6 months, patients with multiple air injection attempts had lower ECD than patients with 1 injection attempt (P < .05).CONCLUSIONS: Different Descemet membrane exposure rates were observed in different diagnoses using the big-bubble technique. Both severe stromal rejection and additional manipulation may have a deleterious effect on the corneal endothelium. (Am J Ophthalmol 2012;154:282-289. 2012 (c) by Elsevier Inc. All rights reserved.)