Vabres B, Bosnjakowski M, Bekri L, Weber M, Pechereau A
Service d'Ophtalmologie, CHU Nantes, Hôtel-Dieu, Place Alexis Ricordeau, 44093 Nantes Cedex 01.
J Fr Ophtalmol. 2006 Apr;29(4):361-71. doi: 10.1016/s0181-5512(06)77694-x.
To determine the advantages, safety, and accuracy of deep anterior lamellar keratoplasty (DLK) versus penetrating keratoplasty (PK) in terms of visual acuity, astigmatism, and endothelial preservation in corneal diseases with healthy endothelium. Of these candidates for keratoplasty, the study investigated keratoconus patients with no other ophthalmic abnormalities.
This comparative nonrandomized retrospective study investigated 22 patients with keratoconus requiring surgery, who underwent keratoplasty in the Nantes University Hospital between 1 June 2002 and 1 January 2004. Ten DLK, ten PK and two PK converted DLK cases were analyzed. Follow-up at 2 weeks and at 3, 6, 9, and 18 months is reported for visual acuity, astigmatism, pachymetry, specular microscopy, and intraocular pressure (IOP). Data are compared before and after surgery at each follow-up date.
Preoperative visual acuity improved in both groups from 0.14+/-0.13 to 0.8+/-0.17 postoperatively. There was no significant difference between the two groups before and at each time after surgery for visual acuity and astigmatism (3.5+/-2 diopters in the PK group and 3+/-0.9 D in the DLK group). There was a statistical difference for IOP with two occurrences of increased IOP up to 30 mmHg in the PK group. Endothelial cell count analysis showed an immediate postoperative decrease of 10% in the DLK group (versus approximately 40% in the PK group), remaining rather stable the 1st year (-3.3%), although cell loss in the PK group declined up to 10% more at 18 months.
With no statistical difference between the two groups for visual acuity and astigmatism, DLK is effective. It is safer than PK in terms of IOP disturbance (leading cause of graft failure) and endothelial cell loss. DLK converted into PK (16%) showed the same profile as first-intention PK.
Despite very similar effectiveness, DLK in keratoconus surgery should be proposed rather than PK because it appears safer not only in the short term but also probably in the long term, with no risk of endothelial cell rejection.
在视力、散光以及内皮保存方面，确定深前板层角膜移植术（DLK）与穿透性角膜移植术（PK）相比，对于内皮健康的角膜疾病的优势、安全性和准确性。在这些角膜移植术候选患者中，该研究调查了无其他眼科异常的圆锥角膜患者。
这项比较性非随机回顾性研究调查了2002年6月1日至2004年1月1日期间在南特大学医院接受角膜移植术的22例需要手术的圆锥角膜患者。分析了10例DLK、10例PK以及2例由PK转为DLK的病例。报告了术后2周以及3、6、9和18个月时的视力、散光、角膜厚度测量、角膜内皮显微镜检查和眼压（IOP）的随访情况。在每个随访日期对手术前后的数据进行比较。
两组患者术前视力从0.14±0.13提高到术后的0.8±0.17。两组在术后各时间点的视力和散光方面术前和术后均无显著差异（PK组为3.5±2屈光度，DLK组为3±0.9屈光度）。PK组有2次眼压升高至30 mmHg，眼压方面存在统计学差异。角膜内皮细胞计数分析显示，DLK组术后立即下降10%（而PK组约为40%），第一年保持相对稳定（-3.3%），尽管PK组在18个月时细胞损失下降了10%以上。
在视力和散光方面两组无统计学差异，DLK是有效的。在眼压紊乱（移植失败的主要原因）和角膜内皮细胞损失方面，DLK比PK更安全。转为PK的DLK（16%）与初次PK表现相同。
尽管有效性非常相似，但圆锥角膜手术中应首选DLK而非PK，因为它不仅在短期内而且可能在长期内看起来更安全，不存在角膜内皮细胞排斥风险。
