Löw U, Kohlhof J K, Ruprecht K W, Hille K
Universitäts-Augenklinik, Homburg (Saar).
Klin Monbl Augenheilkd. 2006 Apr;223(4):289-93. doi: 10.1055/s-2005-858719.
Deep lamellar KPL can be considered as an alternative for penetrating KPL in pathologies of corneal stroma, because there is no risk of decompensation of the endothelium or corneal rejection. Nevertheless, it is well know in lamellar keratoplasty that scars may occur in the interface which can limit the final visual acuity. In a retrospective study we compared the postoperative development of visual acuity and refractive values in deep lamellar keratoplasty with a penetrating procedure.
16 consecutive patients (mean age 48 years) with corneal stroma pathologies such as corneal ulcer, alkali burn and keratoconus underwent deep lamellar KPL. The control group consisted of 38 patients (mean age 42 years) with keratoconus who received a penetrating keratoplasty. Visual acuity and subjective spherical and cylindrical values of the refraction were evaluated preoperatively and after 6 weeks, 6 months and 1 year.
The mean postoperative visual acuity (VA), spherical (SV) and cylindrical (CV) values of the deep lamellar group (results of the control group in brackets) were at 6 weeks VA = 0.24 +/- 0.24 (0.37 +/- 0.23), SV = 0.325 +/- 5.3 dpt, CV = - 1.66 +/- 0.67 dpt (- 3.08 +/- 1.93 dpt), after 6 months VA = 0.38 +/- 0.28 (0.53 +/- 0.31), SV = - 3.0 +/- 4.42 dpt (0.33 +/- 1.93 dpt), CV = - 2.57 +/- 2.03 dpt (- 2.35 +/- 1.32 dpt) and after 1 year VA = 0.41 +/- 0.27 (0.57 +/- 0.26), SV = - 2.57 +/- 4.62 dpt (0.17 +/- 3.98 dpt), CV = - 2.75 +/- 1.25 dpt (- 0.34 +/- 1.86 dpt). There was no significant difference in all the parameters between the two groups.
As the good functional results of deep lamellar KPL are comparable to those of penetration KPL and the risk of endothelial decompensation or rejection is lower in a lamellar procedure, we suggest the use of a deep lamellar KPL in patients with an intact endothelium.
在角膜基质病变中，深板层角膜移植术可被视为穿透性角膜移植术的一种替代方法，因为不存在内皮失代偿或角膜排斥反应的风险。然而，在板层角膜移植术中，众所周知，界面可能会出现瘢痕，这可能会限制最终视力。在一项回顾性研究中，我们比较了深板层角膜移植术与穿透性手术术后视力和屈光值的发展情况。
16例连续的角膜基质病变患者（平均年龄48岁），如角膜溃疡、碱烧伤和圆锥角膜，接受了深板层角膜移植术。对照组由38例圆锥角膜患者（平均年龄42岁）组成，他们接受了穿透性角膜移植术。术前以及术后6周、6个月和1年评估视力以及主观验光的球镜和柱镜值。
深板层组术后平均视力（VA）、球镜（SV）和柱镜（CV）值（括号内为对照组结果）在6周时分别为VA = 0.24 ± 0.24（0.37 ± 0.23），SV = 0.325 ± 5.3 dpt，CV = -1.66 ± 0.67 dpt（-3.08 ± 1.93 dpt）；6个月时分别为VA = 0.38 ± 0.28（0.53 ± 0.31），SV = -3.0 ± 4.42 dpt（0.33 ± 1.93 dpt），CV = -2.57 ± 2.03 dpt（-2.35 ± 1.32 dpt）；1年后分别为VA = 0.41 ± 0.27（0.57 ± 0.26），SV = -2.57 ± 4.62 dpt（0.17 ± 3.98 dpt），CV = -2.75 ± 1.25 dpt（-0.34 ± 1.86 dpt）。两组所有参数均无显著差异。
由于深板层角膜移植术的良好功能结果与穿透性角膜移植术相当，且板层手术中内皮失代偿或排斥反应的风险较低，我们建议对内皮完整的患者使用深板层角膜移植术。
