Xu Jian-jiang, Le Qi-hua, Sun Xing-huai, Zhang Chao-ran, Wang Yan, Hong Jia-xu
Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, China.
Zhonghua Yan Ke Za Zhi. 2007 Jul;43(7):583-8.
To investigate the therapeutic outcomes of deep lamellar keratoplasty (DLKP) and penetrating keratoplasty (PKP) for keratoconus.
Retrospective review of 29 eyes of 29 keratoconus patients, who underwent surgery in Eye & ENT Hospital of Fudan University from April in 2003 to April in 2006. Eleven eyes underwent DLKP and the rest had PKP. Pre- and post-operative visual acuity, astigmatism, complications and post-operative graft status were assessed.
82% of patients (9 eyes) in DLKP group gained BCVA better than 0.5, while in PKP group the proportion was just 78% (14 eyes). Postoperative astigmatism of two groups had no statistical significant difference with the value (-4.03 +/- 1.87) D and (-3.43 +/- 2.31) D respectively (DS: t = 2.135, P = 0.460, DC: t = -0.643, P = 0.528). The confocal image of epithelial cell, basal epithelium and Bowman's membrane was similar to that of normal cornea. The stromal cell was a little bit smaller and disordered. The endothelium in DLKP-treated eyes had normal cellular size and shape. There was no statistical significance between the density of operated eyes and contralateral unoperated eyes (2311.72 +/- 439.73) cells/mm2 and (2477.81 +/- 535.92) cells/mm2 respectively (t = 1.060, P = 0.780). However, the endothelial cells in PKP-treated eyes were highly pleomorphic with a decreased cellular density of (1642.17 +/- 583.41) cells/mm2, whereas the contralateral unoperated eyes had endothelium density of (2739.05 +/- 401.77) cells/mm2. The difference was statistical significance (Z = 7.32, P = 0.006). Complication rates were similar for DLKP and PKP, although the classification of the complications varied, being less severe in the DLKP group.
DLKP seems to be a safe alternative for patients with keratoconus because of its equivalent effect to PKP. DLKP is more technically challenging but allows the risk of endothelial rejection to be avoided and may reduce the risk of late endothelial failure.
探讨深板层角膜移植术（DLKP）和穿透性角膜移植术（PKP）治疗圆锥角膜的疗效。
回顾性分析2003年4月至2006年4月在复旦大学附属眼耳鼻喉科医院接受手术的29例圆锥角膜患者的29只眼。11只眼行DLKP，其余行PKP。评估术前、术后视力、散光、并发症及术后植片情况。
DLKP组82%（9只眼）患者的最佳矫正视力（BCVA）优于0.5，而PKP组这一比例仅为78%（14只眼）。两组术后散光分别为（-4.03±1.87）D和（-3.43±2.31）D，差异无统计学意义（顺规散光：t = 2.135，P = 0.460；逆规散光：t = -0.643，P = 0.528）。共聚焦显微镜下上皮细胞、基底上皮和Bowman膜的图像与正常角膜相似。基质细胞稍小且排列紊乱。DLKP治疗眼的内皮细胞大小和形态正常。手术眼与对侧未手术眼的内皮细胞密度分别为（2311.72±439.73）个/mm²和（2477.81±535.92）个/mm²，差异无统计学意义（t = 1.060，P = 0.780）。然而，PKP治疗眼的内皮细胞高度多形性，细胞密度降低至（1642.17±583.41）个/mm²，而对侧未手术眼的内皮细胞密度为（2739.05±401.77）个/mm²。差异有统计学意义（Z = 7.32，P = 0.006）。DLKP和PKP的并发症发生率相似，尽管并发症的分类有所不同，DLKP组的并发症较轻。
DLKP对圆锥角膜患者似乎是一种安全的替代方法，因为其效果与PKP相当。DLKP技术上更具挑战性，但可避免内皮排斥反应的风险，并可能降低晚期内皮功能衰竭的风险。
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