Deep lamellar keratoplasty by intracorneal dissection - A prospective clinical and confocal microscopic study
Deep lamellar keratoplasty by intracorneal dissection - A prospective clinical and confocal microscopic study
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DOI：
10.1016/j.ophtha.2006.01.071
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发表时间：
2006-08-01
期刊：
影响因子：
13.7
通讯作者：
Sbabo, Arianna
中科院分区：
文献类型：
--
作者：
Marchini, Giorgio;Mastropasqua, Leonardo;Sbabo, Arianna
目的：评估有意保留最后基质的手动深板层角膜移植术 (DLKP) 手术技术的临床结果、视力结果和共焦显微镜角膜特征。设计：非比较性、前瞻性、12 个月的介入研究。参与者：45 名患者的 46 只眼睛，这些患者具有角膜病理特征，无内皮异常，需要角膜移植，通过手动基质进行 DLKP 治疗。分层。手术后对它们进行临床检查，并在 2 周和 1、3、6 和 12 个月时使用体内共聚焦显微镜进行检查。 干预：手术技术包括通过距离后弹力层 (DM) 50 μm 处的 4 mm 角膜缘切口进行角膜内深层手动基质解剖。环钻后，缝合游离内皮移植物。主要指标：形貌参数、界面深度和反射率、前后界面角膜细胞密度；视力与这些参数相关。结果：两只眼睛出现DM 破裂。由于基质炎症导致移植物覆盖而导致上皮愈合延迟的两只眼睛接受了第二次手术（穿透性角膜移植术）。 12 岁时，最小分辨率角 (logMAR) 未矫正视力和 logMAR 最佳矫正视力 (BCVA) 的平均未矫正对数分别从术前值（分别为 1.342 +/- 0.239 和 0.923 +/- 0.226）改善至 0.421 +/- 0.122 和 0.104 +/- 0.068几个月。缝线调整后 3 个月时，平均地形散光为 3.09 +/- 1.30 屈光度 (D)，拆线后 12 个月时，平均地形散光为 2.87 +/- 0.92 D。 15 天时平均界面深度为 64.2 +/- 6.7 μm，并且在 12 个月内没有显示出显着变化。平均界面反射率在第 15 天时最高（95.5 +/- 15.7 光反射率单位 [LRU]），并随着时间的推移逐渐下降，在 12 个月时为 55.3 +/- 8.7 LRU。在长达 1 个月的时间内，BCVA 与地形散光之间以及从术后 6 个月开始，BCVA 与界面反射率之间均观察到显着的负相关。 结论：通过角膜内剥离进行的深板层角膜移植术提供了与其他 DLKP 技术相当的视觉和临床结果。视力恢复是缓慢且渐进的，需要长达一年的时间。共聚焦显微镜能够精确评估角膜特征、界面形态特征和反射率，证明界面反射率和BCVA之间呈负相关，表明界面透明度在数月内的逐步恢复与6个月后视力的增加相关。
Objective: To evaluate the clinical findings, visual outcomes, and confocal microscopic corneal features of a surgical technique for manual deep lamellar keratoplasty (DLKP) with intentional sparing of the most posterior stroma.Design: Noncomparative, prospective, 12-month interventional study.Participants: Forty-six eyes of 45 patients who had corneal pathologic features without endothelial abnormalities and requiring corneal graft were treated by DLKP by manual stromal delamination. They were examined clinically after surgery and using in vivo confocal microscopy at 2 weeks and 1, 3, 6, and 12 months.Intervention: The surgical technique consisted of an intracorneal deep manual stromal dissection through a 4-mm limbal incision at 50 mu m from Descemet's membrane (DM). After trephination, an endothelial free graft was sutured.Main Outcome Measures: Topographic parameters, interface depth and reflectivity, and anterior and postinterface keratocyte density; visual acuity was correlated with these parameters.Results: Two eyes had rupture of the DM. Two eyes that had delayed epithelial healing because of graft override with stromal inflammation underwent a second surgery (penetrating keratoplasty). Mean uncorrected logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity and logMAR best-corrected visual acuity (BCVA) improved from preoperative values (1.342 +/- 0.239 and 0.923 +/- 0.226, respectively) to 0.421 +/- 0.122 and 0.104 +/- 0.068, respectively, at 12 months. Mean topographic astigmatism was 3.09 +/- 1.30 diopters (D) at 3 months after suture adjustment, and 2.87 +/- 0.92 D at 12 months after suture removal. Average interface depth was 64.2 +/- 6.7 mu m at 15 days and showed no significant changes up to 12 months. Mean interface reflectivity was highest at 15 days (95.5 +/- 15.7 light reflectance units [LRU]) and showed a progressive decrease over time of 55.3 +/- 8.7 LRU at 12 months. A significant negative correlation was observed between BCVA and topographic astigmatism up to 1 month and between BCVA and interface reflectivity starting from 6 months after surgery.Conclusions: Deep lamellar keratoplasty by intracorneal dissection provides visual and clinical results comparable with that of other DLKP techniques. Visual recovery is slow and progressive, taking up to 1 year. Confocal microscopy enables precise evaluation of corneal features, interface morphologic features, and reflectivity, demonstrating a negative correlation between interface reflectivity and BCVA showing that the progressive recovery over months of the interface transparency is correlated with the increase in visual acuity after 6 months.