Deep Anterior Lamellar Keratoplasty as an Alternative to Penetrating Keratoplasty A Report by the American Academy of Ophthalmology
Deep Anterior Lamellar Keratoplasty as an Alternative to Penetrating Keratoplasty A Report by the American Academy of Ophthalmology
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DOI：
10.1016/j.ophtha.2010.11.002
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发表时间：
2011-01-01
期刊：
影响因子：
13.7
通讯作者：
Shtein, Roni M.
中科院分区：
文献类型：
--
作者：
Reinhart, William J.;Musch, David C.;Shtein, Roni M.
目的：回顾有关深前板层角膜移植术（DALK）的已发表文献，比较DALK与穿透性角膜移植术（PK）的最佳眼镜矫正视力（BSCVA）、屈光不正、免疫移植排斥反应和移植物存活率的结果。方法：在PubMed和科克伦图书馆数据库中进行同行评审文献的检索。检索仅限于1997年开始的引文，最近一次检索是在2009年5月。检索在英文期刊中获得了1024条引文。这些文章的摘要进行了审查，并选择了162篇文章可能的临床相关性，其中55人被确定为相关的评估objectives.Results：11 DALK/PK比较研究（II级和III级证据），确定比较DALK和PK程序的结果直接，他们包括481 DALK眼睛和501 PK眼睛。在报告视力和屈光数据的研究中，9项研究中两组之间的BSCVA无显著差异。其中6项研究的等效球镜屈光度无显著差异，其中9项研究的术后散光也无显著差异，尽管两组的散光范围通常较大。DALK眼的内皮细胞密度（ECD）在术后6个月内稳定。在研究完成时，所有研究中DALK组的内皮细胞密度值均较高，一般而言，对于所有报告数据的研究，在术后6个月或更长时间的所有时间点，DALK组和PK组之间的ECD差异均显著。根据1项研究中的II级证据和10项研究中的III级证据，DALK在BSCVA结局指标方面等同于PK，特别是如果手术技术产生最小的残留宿主基质厚度。对于屈光不正结局，DALK没有优势。虽然DALK的移植物存活率改善尚未得到证实，但术后数据表明DALK在保留ECD方面上级PK。DALK后不会发生内皮免疫移植物排斥反应，与PK眼相比，这可能简化DALK眼的长期管理。作为一种眼外手术，DALK具有重要的理论安全性优势，是内皮未受损的角膜疾病患者视力康复的良好选择。
Objective: To review the published literature on deep anterior lamellar keratoplasty (DALK) to compare DALK with penetrating keratoplasty (PK) for the outcomes of best spectacle-corrected visual acuity (BSCVA), refractive error, immune graft rejection, and graft survival.Methods: Searches of the peer-reviewed literature were conducted in the PubMed and the Cochrane Library databases. The searches were limited to citations starting in 1997, and the most recent search was in May 2009. The searches yielded 1024 citations in English-language journals. The abstracts of these articles were reviewed, and 162 articles were selected for possible clinical relevance, of which 55 were determined to be relevant to the assessment objective.Results: Eleven DALK/PK comparative studies (level II and level III evidence) were identified that compared the results of DALK and PK procedures directly; they included 481 DALK eyes and 501 PK eyes. Of those studies reporting vision and refractive data, there was no significant difference in BSCVA between the 2 groups in 9 of the studies. There was no significant difference in spheroequivalent refraction in 6 of the studies, nor was there a significant difference in postoperative astigmatism in 9 of the studies, although the range of astigmatism was often large for both groups. Endothelial cell density (ECD) stabilized within 6 months after surgery in DALK eyes. Endothelial cell density values were higher in the DALK groups in all studies at study completion, and, in general, the ECD differences between DALK and PK groups were significant at all time points at 6 months or longer after surgery for all of the studies reporting data.Conclusions: On the basis of level II evidence in 1 study and level III evidence in 10 studies, DALK is equivalent to PK for the outcome measure of BSCVA, particularly if the surgical technique yields minimal residual host stromal thickness. There is no advantage to DALK for refractive error outcomes. Although improved graft survival in DALK has yet to be demonstrated, postoperative data indicate that DALK is superior to PK for preservation of ECD. Endothelial immune graft rejection cannot occur after DALK, which may simplify long-term management of DALK eyes compared with PK eyes. As an extraocular procedure, DALK has important theoretic safety advantages, and it is a good option for visual rehabilitation of corneal disease in patients whose endothelium is not compromised.