深层板层角膜移植术与穿透性角膜移植术治疗角膜病变的比较

Deep lamellar keratoplasty versus penetrating keratoplasty for corneal lesions.

作者信息

Panda A, Bageshwar L M, Ray M, Singh J P, Kumar A

机构信息

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi.

出版信息

Cornea. 1999 Mar;18(2):172-5. doi: 10.1097/00003226-199903000-00005.

DOI:10.1097/00003226-199903000-00005

PMID:10090362

Abstract

PURPOSE

To compare the effectiveness of deep lamellar keratoplasty (DLK) with that of penetrating keratoplasty (PKP) in cases of corneal lesions not involving the endothelium.

METHODS

Forty-eight eyes with leukomatous corneal opacity (n = 33), keratoconus with apical scarring (n = 6), granular corneal dystrophy (n = 5), lattice corneal dystrophy (n = 2), and multiple corneal foreign bodies (n = 2) in an age group varying from 16 to 53 years underwent DLK (n = 24) and PKP (n = 24) by utilizing B and (B+ and A) grade M-K preserved donor tissue, respectively. The patients were followed up closely, and the graft clarity, visual achievement, astigmatism and endothelial cell count were evaluated at repeated occasions up to 1 year.

RESULTS

Astigmatism of <3 diopters (D) and > or = 5D was obtained in 19 eyes and one eye, respectively, after DLK at 6 months, whereas six eyes of the PKP group had astigmatism <3D, and 12 eyes had > or = 5D at the end of 6 months. The same at 1 year was observed in 20 and one eye in the DLK and eight and five eyes of the PKP group. Astigmatism of > or = 5D at the end of 6 months in both the groups showed highly significant changes (p < 0.001). Best corrected visual acuity of 6/18 or more was achieved in 18 and 12 eyes at 6 months after DLK and PKP, respectively, which were statistically highly significant (p < 0.001), whereas at 1 year, it was seen in 17 and 15 eyes of the DLK and PKP groups, respectively, which was nonsignificant. The mean endothelial cell count was 2,233.3+/-64.453 cells/mm2 and 2,219.6+/-102.48 cells/mm2 at 6 months and I year, respectively, after DLK, which was nonsignificant. The mean cell count of the donor eyes used for PKP was 2,191+/-52.164 cells/mm2, 1,902.8+/-70.346 cells/mm2 at 6 months, and 1,579.0+/-80.24 cells/mm2 at 1 year. All the values showed highly significant changes (p < 0.001). Further, the graft clarity of > or = 3+ was achieved in 20 and 18 eyes at 6 months postoperatively in the DLK and PKP groups, whereas the same was observed in 19 and 13 eyes of both the groups, respectively, at 1-year follow-up.

CONCLUSION

DLK is a promising procedure and should be practiced more frequently for corneal pathology not involving the endothelium.

摘要

目的

比较深板层角膜移植术（DLK）与穿透性角膜移植术（PKP）在不涉及内皮的角膜病变病例中的有效性。

方法

年龄在16至53岁之间的48只眼，其中患有白色角膜混浊（n = 33）、圆锥角膜伴顶端瘢痕（n = 6）、颗粒状角膜营养不良（n = 5）、格子状角膜营养不良（n = 2）和多发性角膜异物（n = 2），分别采用B级和（B +级和A级）M - K保存的供体组织进行DLK（n = 24）和PKP（n = 24）。对患者进行密切随访，并在长达1年的时间内多次评估植片清晰度、视力、散光和内皮细胞计数。

结果

DLK术后6个月时，分别有19只眼和1只眼获得了<3屈光度（D）和≥5D的散光，而PKP组在6个月末有6只眼散光<3D，12只眼≥5D。DLK组和PKP组在1年时分别为20只眼和1只眼以及8只眼和5只眼。两组在6个月末≥5D的散光显示出高度显著变化（p < 0.001）。DLK和PKP术后6个月时，分别有18只眼和12只眼达到了最佳矫正视力6/18或更好，差异具有统计学高度显著性（p < 0.001），而在1年时，DLK组和PKP组分别为17只眼和15只眼，差异无统计学意义。DLK术后6个月和1年时，平均内皮细胞计数分别为2,233.3±64.453个细胞/mm²和2,219.6±102.48个细胞/mm²，差异无统计学意义。用于PKP的供体眼的平均细胞计数在6个月时为2,191±52.164个细胞/mm²，在1年时为1,902.8±70.346个细胞/mm²，在1年时为1,579.0±80.24个细胞/mm²。所有这些值均显示出高度显著变化（p < 0.001）。此外，DLK组和PKP组术后6个月时分别有20只眼和18只眼达到了≥3+的植片清晰度，而在1年随访时，两组分别为19只眼和13只眼。