Department of Ophthalmology, Misericordia Hospital, Grosseto, Italy.
Cornea. 2010 Jan;29(1):60-4. doi: 10.1097/ICO.0b013e3181a317d3.
To report our experience with deep anterior lamellar keratoplasty (DALK) for the treatment of corneal opacities following herpetic keratitis.
A total of 52 eyes of 52 patients with postherpetic stromal scars with intact endothelium were treated in our department with DALK between 2002 and 2006 as a surgical approach to restore corneal transparency. The main outcome measures of the study were the ability to successfully expose DM (descemetic DALK, dDALK), the number of cases with predescemetic plane achieved surgical plane (pdDALK), pre- and postoperative visual acuity, and endothelial cell count. The mean follow-up period was 31 months. Therapeutic protocol, recurrence of herpetic keratitis, and corneal rejection were evaluated.
dDALK was done in 45 of 52 cases (86.5%) and pdDALK was done in 7 of 52 cases (13.5%). Ruptures of Descemet's membrane occurred in 2 of 52 cases (3.8%) in our series. No case was converted to penetrating keratoplasty. Postoperative best-spectacle-corrected visual acuity was 20/20 in 27 of 52 cases (52%) and at least 80% of patients achieved 20/30 at long-term follow-up. Average endothelial cell loss was 205.32 cell/mm. Therapeutic protocol was conducted with long-term therapy with oral antiviral drugs and topic steroids after DALK. No episode of rejection or recurrence was detected in these patients through their last visit.
DALK is an alternative and safe procedure to restore vision in cases with significant corneal scarring due to recurrent HSV keratitis with healthy endothelium. Pre- and postoperative antiviral prophylaxis is necessary to prevent recurrence.
报告我们在深层前板层角膜移植术（DALK）治疗疱疹性角膜炎后角膜混浊方面的经验。
2002 年至 2006 年期间，我们科室共对 52 例 52 只眼的疱疹性角膜炎后基质瘢痕伴完整内皮患者行 DALK 治疗，作为恢复角膜透明性的手术方法。该研究的主要观察指标为成功暴露 DM（无接触性 DALK，dDALK）的能力、达到术前平面的病例数（pdDALK）、术前和术后视力以及内皮细胞计数。平均随访时间为 31 个月。评估治疗方案、疱疹性角膜炎复发和角膜排斥反应。
在 52 例患者中，45 例（86.5%）行 dDALK，7 例（13.5%）行 pdDALK。在我们的研究中，有 2 例（3.8%）发生了后弹力层破裂。没有病例转为穿透性角膜移植。术后最佳矫正视力为 20/20 的有 27 例（52%），至少 80%的患者在长期随访中达到 20/30。平均内皮细胞丢失 205.32 个细胞/mm。DALK 后行长期口服抗病毒药物和局部皮质类固醇治疗。在最后一次随访时，这些患者均未出现排斥或复发。
DALK 是一种替代方法，对于复发性 HSV 角膜炎伴健康内皮的严重角膜混浊患者，可以安全恢复视力。在手术前后进行抗病毒预防是必要的，以防止复发。
