Comparative cohort study of the outcomes of deep lamellar keratoplasty and penetrating keratoplasty for keratoconus
Comparative cohort study of the outcomes of deep lamellar keratoplasty and penetrating keratoplasty for keratoconus
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DOI：
10.1038/sj.eye.6701903
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发表时间：
2006-05-01
期刊：
影响因子：
3.9
通讯作者：
Noble, BA
中科院分区：
文献类型：
--
作者：
Funnell, CL;Ball, J;Noble, BA
目的比较深板层角膜移植术（DLK）和穿透性角膜移植术（PK）治疗圆锥角膜的疗效和并发症。PK在2000年6月至2001年7月之间进行，DLK在2001年10月至2002年10月之间进行。手术由一名外科医生进行。记录手术时、术后6个月和12个月的最佳矫正视力（BCVA）、屈光度和并发症。采用卡方检验比较视力结果，采用独立t检验分析散光。所有PK均不复杂。DLK组中有2例出现后弹力膜微穿孔。PK组和DLK组达到6/9或更好的患者比例无显著差异（85 vs 78%，P = 0.54）。然而，PK患者比DLK患者更有可能在1年时达到6/6; PK患者为70%（14/20），DLK患者为22%（4/18）（P = 0.04）。与DLK组相比，PK组的散光显著更高（P = 0.022）。PK组有两例移植物排斥反应，而没有DLKs.Conclusions本研究证实了良好的视觉效果，PK和DLK在圆锥角膜同样高的百分比达到6/9 BCVA。DLK似乎引起较少的散光，并且还具有无内皮移植物排斥的优点。然而，明显的代价是降低了达到6/6 BCVA的可能性。
Aim To compare the outcomes and complications of deep lamellar keratoplasty (DLK) and penetrating keratoplasty (PK) for keratoconus.Methods A cohort of 20 consecutive PKs, for keratoconus, was compared with 20 consecutive DLKs, for keratoconus. The PKs were performed between June 2000 and July 2001, the DLKs between October 2001 and October 2002. Surgery was performed by one surgeon. Best-corrected visual acuities (BCVA), refraction and complications were recorded at the time of surgery, 6 and 12 months postoperatively. chi(2)-tests were used to compare visual acuity outcomes and independent t-tests in the analysis of astigmatism.Results Groups were comparable for age, sex, and ethnicity. All PKs were uncomplicated. Two of the DLK group had microperforations of Descemet's membrane. There was no significant difference in the proportion of patients achieving 6/9 or better between the PK and DLK groups (85 vs 78%, P = 0.54). PK patients were, however, more likely than the DLKs to achieve 6/6 at 1 year; 70% (14/20) of PKs compared to 22% of (4/18) DLKs (P = 0.04). Astigmatism was significantly higher in the PKs compared to the DLKs (P = 0.022). There were two cases of graft rejection in the PK group, while none in the DLKs.Conclusions This study confirms good visual results from both PK and DLK in keratoconus with similarly high percentages reaching 6/9 BCVA. DLK appears to cause less astigmatism and also has the advantage of no endothelial graft rejection. The apparent cost, however, is a reduction in the likelihood of achieving 6/6 BCVA.